Case Repository| Volume 47, ISSUE 11, P1123.e1-1123.e5, November 2022

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Forequarter Replantation

Published:September 21, 2021DOI:
      Traumatic forequarter amputations are rare injuries in which the arm, clavicle, scapula, and proximal shoulder muscles are avulsed from the body. Historically, forequarter amputation has been treated with hemorrhage control, wound debridement, and soft tissue coverage. To our knowledge, successful forequarter replantation has not been previously reported. We present a rare case of forequarter amputation treated successfully with replantation. At the 4.5-year follow-up after replantation, the patient had antigravity elbow flexion, modest shoulder elevation, modest extrinsic finger function, and crude sensation. We discuss relevant technical considerations that indicate that, despite challenges, forequarter replantation can be achieved with success.

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        • Layton T.R.
        • Villella E.R.
        • Marrangoni A.G.
        Traumatic forequarter amputation.
        J Trauma. 1981; 21: 411-412
        • Venkataram A.
        • Shetty N.
        • Mashalkar N.S.
        • Dsouza N.
        Forequarter replantation and the lessons learnt.
        Plast Reconstr Surg Glob Open. 2015; 3: e509
        • Sabapathy SR Venkateswaran G.
        • Boopathi V.
        • Subramanian J.B.
        “On arrival block”-management of upper extremity trauma with resuscitation in the operating room.
        Plast Reconstr Surg Glob Open. 2020; 8e3191
        • Sabapathy S.R.
        • Elliot D.
        • Venkatramani H.
        Major replantation.
        in: Boyd B. Jones N.F. Operative Microsurgery. McGraw Hill, 2015: 698-719
        • Sabapathy S.R.
        • Venkatramani H.
        • Bharathi R.R.
        • Dheenadhayalan J.
        • Bhat V.R.
        • Rajasekaran S.
        Technical considerations and functional outcome of 22 major replantations (The BSSH Douglas Lamb Lecture, 2005).
        J Hand Surg Eur Vol. 2007; 32: 488-501
        • Larson J.V.
        • Kung T.A.
        • Cederna P.S.
        • Sears E.D.
        • Urbanchek M.G.
        • Langhals N.B.
        Clinical factors associated with replantation after traumatic major upper extremity amputation.
        Plast Reconstr Surg. 2013; 132: 911-919
        • Wang C.
        • Askari M.
        • Zhang F.
        • Lineaweaver W.C.
        Long-term outcomes of arm replantation.
        Ann Plast Surg. 2020; 84: S151-S157
        • Otto I.A.
        • Kon M.
        • Schuurman A.H.
        • van Minnen L.P.
        Replantation versus prosthetic fitting in traumatic arm amputations: a systematic review.
        PLoS One. 2015; 10e0137729
        • Pet M.A.
        • Morrison S.D.
        • Mack J.S.
        • et al.
        Comparison of patient-reported outcomes after traumatic upper extremity amputation: replantation versus prosthetic rehabilitation.
        Injury. 2016; 47: 2783-2788
        • Bhagia S.M.
        • Elek E.M.
        • Grimer R.J.
        • Carter S.R.
        • Tillman R.M.
        Forequarter amputation for high-grade malignant tumours of the shoulder girdle.
        J Bone Joint Surg Br. 1997; 79: 924-926