A serious complication after forearm replantation caused by a cord tightened on the stump during transportation – a case report

Dawid Ciechanowicz, Joanna Antoniak, Andrzej Żyluk


In amputations of an upper extremity, an adequate preservation of the amputated part during its transport to a replantation centre is very important: it needs to be maintained at about 4°C. Providing adequate haemostasis of the extremity stump is also important for the patient’s safety, to avoid bleeding on the journey. The article presents the case of a patient who had sustained a hand amputation at the forearm, in which bleeding from the stump was stopped with a cord that has been tightened on the forearm, 10 cm above the amputation site. Transport for the patient took over 6 h and resulted in a critical ischaemia of the forearm stump. Replantation was successfully performed, but an excessive oedema of the ischaemically injured part of the stump developed in the post-operative course, requiring a fasciotomy, resection of the necrotic muscles, following by coverage of the defects with skin grafts. No complications were observed in the replanted part of the forearm, and the prognosis towards recovery of good hand function is moderate, due to the loss of a portion of the forearm muscles.


hand replantation; postoperative complications; muscle ischaemia; malpractice

Full Text:

PDF Zdalny


Smith AR, van Alphen B, Faithfull NS, Fennema M. Limb preservation in replantation surgery. Plast Reconstr Surg 1985;75(2):227-37.

Foucher G, Sammut D. Preoperative cooling and storage of amputated digits. J Reconstr Microsurg 1990;6(1):71.

Żyluk A. Replantacje. In: Żyluk A, editor. Mikrochirurgia. Warszawa: Medipage; 2019. p. 96-8.

Hoang N, Hai LH, Staudenmaier R, Hoehnke C. Complete middle forearm amputations after avulsion injuries – microsurgical replantation results in Vietnamese patients. J Trauma 2009;66(4):1167-72.

Patel AA, Blount AL, Owens PW, Askari M. Functional outcomes of replantation following radiocarpal amputation. J Hand Surg Am 2015;40(2):266-70.

Solarz MK, Thoder JJ, Rehman S. Management of major traumatic upper extremity amputations. Orthop Clin North Am 2016;47(1):127-36.

Assouline U, Feuvrier D, Lepage D, Tropet Y, Obert L, Pauchot J. Functional assessment and quality of life in patients following replantation of the distal half of the forearm (except fingers): A review of 11 cases. Hand Surg Rehabil 2017;36(4):261-7.

DOI: https://doi.org/10.21164/pomjlifesci.696

Copyright (c) 2020 Dawid Ciechanowicz, Joanna Antoniak, Andrzej Żyluk

License URL: https://creativecommons.org/licenses/by-nc-nd/3.0/pl/