پيوند دست قطع شده از سطح كف دست: گزارش موردي

Complete amputation of the palm and replantation: case report

زمینه و هدف: قطع كامل دست از سطح كف دست در اثر كار با اشیاء برقی تیز و برنده زندگی روزمره افراد را مختل می‌نماید. پیوند عضو آسیب دیده موجب بهبود كیفیت زندگی فرد و شكل ظاهری و توان عملكردی اندام مورد نظر می‌شود. معرفی بیمار: بیمار مرد جوانی كه در حین كار كردن با دستگاه علف بر برقی دچار قطع كامل دست راست از ناحیه وسط كف دست شده بود به‌طوری‌كه همزمان دچار تخریب و له شدگی شدید بند دیستال انگشت اول دست راست نیز شده بود. بیمار پس از مراجعه به اورژانس بیمارستان دكتر فاطمی شهرستان اردبیل، (سال 1392 بهمن ماه) تحت عمل جراحی پیوند كف دست قطع شده قرار گرفت. نتیجه‌گیری: قطع كامل دست و پیوند موفقیت‌آمیز آن جزو موارد كمیاب و قابل گزارش می‌باشد. پیوند دست از ناحیه قطع شده كامل كف دست و پیگیری‌های بیمار در طی 10 ماه حاكی از موفقیت‌آمیز بودن عمل داشت. خون‌رسانی دست بیمار و حركات انگشت و پیشرفت عصبی از نظر حسی در طی این مدت در حد قابل قبول بود.

Background: Even though replantation surgery has now become a routine procedure, it remains delicate and demanding surgery, requiring adequate training and expertise in microsurgical techniques. Functional outcomes following replantation vary with the level of injury. Replants of the fingers distal to the flexor superficial are insertion, the hand at the wrist, and the upper extremity at the distal forearm can achieve good function. With the advent of refined microscopes, sutures, and needles, along with specialized surgical training, replantation has become a routine part of hand-surgery practice in centers all over the world. Clearly, survival does not equate with function. Amputations constitute multisystem injury, with disruption of skeletal support (bone), motor function (muscle), sensibility (nerve), circulation (blood vessel), and soft-tissue coverage (skin). A lot of News work-related accidents published daily. Complete amputation of the palm with sharp objects electric disrupts quality of life and irreversible effects on their life. Replantation or repair the damaged organ can improve their quality of life, functional body. Case presentation: The case is a man with complete amputation of the palm while working with an electrical machine, at the same time as damage and severe crush was also the distal phalanx of the first finger of the right hand. Patient was admitted to the emergency unit at Fatemi Hospital of Ardabil city in January 2014, Iran, and underwent to surgery for replantation. Conclusion: Complete amputation of palm and its successful replantation are among rarely occurred and reportable cases. Complete amputation of palm and successful replantation and the 10-month follow-up indicated that the patient had a successful operation. No abnormalities were found in the blood circulation, and finger grasping was acceptable. Nerve development was acceptable.