Replantation of Hand Amputated Through the Palmar Arch Level

Yoo, Myung Chul; Kang, Shin Hyeok; Kim, Hoi Chang; Lee, Young Girl

Abstract

The value of replantation of parts of the upper limb is well established and replantation of a digit has now be come a standard procedure. However, there are few reports of replantation of hand amputated through the palmar arch level. We have reviewed 14 cases of 14 patients replantation of hand amputated through the arterial palmar arch level from Mar. 1976 through Mar. 1982. The success rate in our series is 64 percent. This is slightly lower than the other levels due to its anatomical complexity. According to the anatomical complexity and distribution of nerves and vessels, it is divided to three levels. In level A, the superficial palmar arch and/or the deep palmar arch should be repaired. In level B, the princeps pollicis artery should be repaired after anastomosis of the superficial and deep palmar arch. In level C, each common palmar digital artery should be repaired but if it is impossible to repair of all fingers, replantation of thumb and index should be performed as possible. Meticulous microsurgical technique and precise anatomical knowledge is mandatory for replantation of the palmar arch level.