گزارش یک مورد قطع کامل بازو و پیوند مجدد آن

Complete traumatic maior amputation of through proximal Humerus is extremely rare. Selection of a amputated limb for replantation is based on the type, time, location, age, and underling disease of patients. There are many factors which control the functional prognosis of reattached arms. The most important factors are the level of amputation, the severity of crush, ischemic time, and the age of patients.A 35- yr- old man sustained a right upper extremity amputation approximately 6 cm distal to shoulder. Amputated limb was not clean and the patient was admitted to the emergency ward after 1-hour post injury with hypovolemic shock. Resuscitation was performed and amputated part and the limb was cleaned. The first bone stability was done by pin and plaque fixation, and then vascular reconstruction was done by using saphenous vein interposition graft for vein and then to arterial repair. Median, ulnar, and radial nerves were anastomosed with epinural sutures. Ischemic time was approximately 3 hours. The immediate postoperative course was complicated by the infection of the wound and skin necrosis around the wound were treated with repeated debridment and skin grafting. Two years after reimplanation the senses of temperature and response to touch returned to fingertips. Although the function of the replanted arm is far from perfect, the patient was satisfied with his arm. Numerous cases of limb replantation have been reported by many authors with various functional results. We reported a replantation in a patient with proximal part of upper limb amputation that has incomplete function but satisfaction to the patient. In general the recovery of function appears to be more incomplete in proximal limb reimplantations