gms | German Medical Science

Objectives/Interrogation: "Spare parts surgery" is well-described in the plastic surgery literature. In the setting of trauma, otherwise discarded parts can be utilized for reconstruction resulting in a superior functional and aesthetic outcome for the patient.

Methods: Cross arm repalntation was done for 26 years of age patient in 2008 who had train injury. Patient has both hand damages - right hand damage distally to wrist joint and left hand damage at level of the elbow joint. Left elbow joint and right palm were not be able to reconstruct. Therefore left hand (at distal forearm level) was transplanted to right forearm in mirror shape. ALT flap was used to cover soft tissue defect and late wrist arthrodesis was done to improve functional outcome. Functional evaluation as DASH and ROM scores were calculated in the ten year's long term follow up study.

Results and Conclusions: Cross hand replant get good sensation and good grasp and he use hand more than left prosthetic hand. Patient use replanted hand in daily activities and has no complains about thumb's mirror like position.

Train injuries are becoming less common in Latvia. But is very hard to manage as patients usually have shock, all extremities had sever damaged tissues. Very important is to evaluate amputated segment and usually you can find replantable part but as these patients are critically ill you have to work and think very fast therefore short-time replantation can be done. Hand allotransplantation can be as an alternative method but patient have to use immunosuppression for all life. The prosthetic hand has been other option to reconstruct functionality for the hand but it is hard to manage sensation therefore replantation or as this cross hand replantation still have a place in era of modern microsurgery.