Single-stage replantation in crush hand amputation: Decision-making beyond injury mechanism

Hand-level amputation following crush injury presents a major reconstructive challenge, and the choice between single-stage and staged replantation remains controversial. Decision-making is often influenced by the injury mechanism; however, the role of reconstructability is less clearly defined. We report a case of complete traumatic hand amputation due to crush injury treated with single-stage replantation and long-term follow-up. The amputated segment was reconstructable, allowing direct repair of vessels, nerves, and tendons without grafting. Stable skeletal fixation and tension-free anastomosis were achieved within a reasonable operative time. The replanted hand survived without vascular complications. At 9-year follow-up, the patient achieved functional use of the hand in daily activities and returned to manual work despite residual limitation in range of motion. This case highlights that crush injury alone should not preclude a single-stage approach. A simplified decision-making framework is proposed, emphasizing reconstructability and the feasibility of tension-free repair as key determinants. Functional outcomes should be interpreted in terms of practical use rather than maximal joint motion.