1. 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

2. 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

3. 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)

4. Amputated hand with second and third degree burns on dorsal aspect

5. Amputated hand with burns in wound site

6. Amputated hand without burns on palmar aspect

7. 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

8. 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

9. 2nd postoperative day

10. 2nd postoperative day

11. 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 weeks postoperatively
No complications in postoperative period were observed

12. 6th postoperative day – after first necrectomy

13. 6th postoperative day – after first necrectomy

14. 12th postoperative day – after second necrectomy

15. 40th postoperative day

16. 40th postoperative day

17. 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

18. 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