Successful Re-implantation of an amputated hand with abnormal vascular anatomy

Hand amputation is a devastating, usually accidental, injury. Re-implantation of the severed hand is a challenging procedure that requires careful planning, precise microsurgical techniques, and adequate vascular supply. Successful surgical reimplantation therefore requires foresight into unique variant neurovascular anatomy that could be encountered and how these would pose challenges during the procedure. We report the case of a successful complex re-implantation of a distal forearm traumatic amputation, sustained from a chaff cutter, in a 5-year-old male Kenyan patient. The case presented with unique variant anatomy including a persistent dominant median artery, with absent ulnar artery and superficial and deep palmar arches. The ulnar nerve also had a variant coarse that was difficult to locate. We discuss the importance of adjusting surgical approaches for optimal outcomes and highlight the challenges involved in such a complex procedure.