Major hand replantation at the carpometacarpal level: A case report

Major hand replantation at the carpometacarpal level is rare and technically demanding. We report the case of a 69-year-old right-hand-dominant man who sustained traumatic amputation of the right hand while cleaning a metal-cutting guillotine. On admission, he was hemodynamically stable, and physical examination showed complete amputation at the carpometacarpal level with exposed bone and tendons. Radiography confirmed the level of injury. The patient underwent urgent replantation under general anesthesia with Kirschner-wire fixation from the metacarpals to the carpus, arterial anastomosis of the ulnar artery and a radial arterial branch, repair of multiple flexor and extensor tendons, and neurorrhaphy of the median and ulnar nerves. Postoperatively, the replanted hand remained viable, with preserved distal perfusion. The patient developed acute anemia and multifactorial acute kidney injury with concern for ischemia-reperfusion injury, which improved with medical treatment and monitoring. At discharge, the wound was well approximated, distal filling was preserved in all digits, and limited but present motion and partial sensory recovery were noted. Follow-up demonstrated maintained perfusion, stable fixation, and no evidence of infection. This case underscores that carpometacarpal-level hand replantation can achieve successful limb salvage in selected patients when timely multidisciplinary microsurgical management is available.