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Digital replantation in forward surgical units: a cases study
Laurent Mathieu1, Michel Levadoux2, Emmanuel Soucany de Landevoisin3
1Department of orthopedic traumatology reconstructive surgery, Percy Military Hospital, Clamart, France - Department of surgery, French Military Medical Academy, Ecole du Val-de-Grâce, Paris, France.
SICOT-J
|March 17, 2018
Summary
Military surgeons can perform digital replantation in austere settings. While one case showed excellent outcomes, another failed due to evacuation complications, highlighting the challenges of combat zone hand surgery.
Area of Science:
- Trauma Surgery
- Microsurgery
- Military Medicine
Background:
- Noncombat hand injuries, particularly crushing mechanisms leading to digital amputations, are prevalent in military operations.
- Management is complicated by limited microsurgical resources and evacuation delays in combat zones.
Purpose of the Study:
- To describe digital replantation cases performed in French forward surgical units.
- To evaluate the feasibility and outcomes of replantation in austere military environments.
Main Methods:
- Two cases of digital replantation/revascularization in deployed French military surgical units.
- Case 1: Complete distal amputation of the medius replanted on an aircraft carrier.
- Case 2: Ring finger avulsion revascularized in a Role 2 facility.
Main Results:
- Successful replantation of the medius with excellent functional and aesthetic outcomes, with no complications post-evacuation.
- Failure of ring finger revascularization due to arterial thrombosis during evacuation.
Conclusions:
- Digital replantation is feasible in austere combat zone conditions for isolated amputations, provided microsurgical expertise and equipment are available.
- A management algorithm for field amputation is proposed based on amputation type and level.
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