Replantation of the hand with third degree burns – case report Tomas Kubek (1, 2), Pavel Novak (1), Libor Streit (1, 2), Jiri Vesely (1, 2) Department of Plastic and Aesthetic Surgery, St. Anne's University Hospital Brno, Czech Republic; (2) Faculty of Medicine, Masaryk University, Brno, Czech Republic

Introduction Amputation of the hand is considered to be absolute indication for replantation 255 hand replantations and revascularizations, and 110 replantations and revascularizations of distal forearm were performed in our department between 1978-2018

Case report 48-years-old man suffered amputation injury to his left hand while working with circular saw Unfortunately, amputated part fell into a fireplace, which resulted in second and third degree burns on dorsal aspect of the hand and fingers Patientʼs medical history: gastroduodenal ulcer disease smoker (20 cigarettes/day)

Amputated hand with second and third degree burns on dorsal aspect

Amputated hand with burns in wound site

Amputated hand without burns on palmar aspect

Case report – surgical procedure Replantation was performed 5 hours after the accident Radical debridement in wound site Escharotomy Forearm fasciotomy Carpal tunnel release Osteosynthesis with Kirschner wires

Case report – surgical procedure Anastomosis of ulnar artery and cephalic vein restored blood flow in amputated hand very quickly Anastomoses of radial artery and 3 dorsal veins were also performed Tendon repair of all flexors and extensors Median and ulnar nerve repair with epineural microsuture Combined dressing fabric (COM 30) was used for covering defects after escharotomy and fasciotomy Duration of operation: 6,5 hours Good blood circulation in the hand at the end of the operation

2nd postoperative day

2nd postoperative day

Case report – surgical procedure Gentle tangential necrectomy and debridement was performed in two steps during first two weeks Defects after necrectomy were covered by skingrafts in third postoperative week Patient started with active rehabilitation 3 weeks postoperatively No complications in postoperative period were observed

6th postoperative day – after first necrectomy

6th postoperative day – after first necrectomy

12th postoperative day – after second necrectomy

40th postoperative day

40th postoperative day

Case report - results Replantation of the hand with third degree burns was successful No complications occurred during hospital stay, all wounds were healed within 40 days Results of rehabilitation in early postoperative period were promising Unfortunately, the patient failed to cooperate and did not come for follow up

Conclusion Up to now, no case of replantation of hand with burns has been described in literature Despite the initial concerns of the surgical team, third degree burns were not an obstacle to successful hand replantation