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Replantation of amputation at the wrist: challenges of management in sub-Saharan Africa
  1. Chidiebere Peter Echieh1,2,
  2. Mba Ozinko1,
  3. Benjamin Irene Omoregbee3 and
  4. Kelechi Emmanuel Okonta4
  1. 1Department of Surgery, University of Calabar, Calabar, Cross River, Nigeria
  2. 2Department of Surgery, University of Calabar Teaching Hospital, Calabar, Cross River, Nigeria
  3. 3Department of Cardiothoracic Surgery, Castle Hill Hospital, Hull University Teaching Hospital NHS, Kingston-Upon-Hull, UK
  4. 4Department of Surgery, University of PortHarcourt, PortHarcourt, Rivers State, Nigeria
  1. Correspondence to Dr Chidiebere Peter Echieh; cechieh{at}gmail.com

Abstract

Amputations of the upper limb, in particular, have a major impact on patients’ lives, as loss of function can not only cause reduced autonomy in daily life but also hinder social interactions and capacity for work. Replantation at or proximal to the wrist, referred to as wrist-proximal replantation, remains a daunting challenge that presents the hand surgeon with an array of difficulties distinct from digital replantation.We present our experience with a successful replantation of a near-complete amputation at the non-dominant left wrist in a 25-year-old man managed in sub-Saharan Africa. Two years after replantation, the patient had a Disabilities of the Arm, Shoulder and Hand score of 40 and 2-point discrimination of 6 mm. We also discuss the peculiar challenges which have limited the development of replantation in the tropics. Environmental temperatures, manpower, expertise and technology are possible factors that limit this practice in the tropics.

  • prehospital
  • primary care
  • resuscitation
  • trauma

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Footnotes

  • Twitter @echiehcp

  • Contributors CPE was the lead surgeon, prepared the manuscript and approved the final version. MO did the repeat surgery for tendon repair, reviewed the manuscript and approved the final version. BIO reviewed the manuscript and approved the final version. KEO reviewed the manuscript and approved the final version.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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