Management Of Partial Amputation Of The Wrist In Precarious
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Wounds on the ventral side of the wrist are particularly serious, sometimes involving the functional prognosis of the hand. These wounds are responsible for severe motor and sensory sequelae but also pain . The repair of these lesions is a real functional issue. It has been shown that through careful surgery followed by postoperative rehabilitation that good functional results can be obtained. Occupational accidents are the main etiology of these injuries, followed by domestic accidents . The management of these lesions in a very poorly equipped center is a real challenge.

Here is the interesting case report of a 53-year-old, male, right handed, received for open trauma of the left wrist following an accident at work (he was injured by a bar of glass on the ventral side of the wrist). A tourniquet was placed on his arm and he was taken to ward 45 minutes after the accident. Clinical examination revealed a transverse wound of the wrist with severe bleeding with impossibility of active bending of the fingers without rotational disorders, lack of sensitivity in the territories of the naves (radial, median and ulnar), as well as lack of local heat in the hand (re-coloring was greater than 3 seconds). Face and wrist profile X-ray showed bone integrity.

For the surgery, he was placed supine with his left upper limb resting on a tablet with a tourniquet on his arm after loco-regional anesthesia (plexus block). With abundant washing of the wound with isotonic saline serum and then to aseptic draping. At the exploration a large transverse wound on the ventral side of the left wrist with detachment of a fascio-cutaneous flap including the total tendon area of ​​the common flexor muscles (superficial and deep), long flexor digitorum, flexor muscle of carpi, flexor carpi ulnaris, long palmar muscle, and section of nerves (radial, median, and ulnar) and radial and ulnar arteries was found. The tendon ends were identified and maintained by needles. Then, the tendons via KESSLER points reinforced by a pertiginous overgrip were sutured. A perineural epi suture was used to repair three nerves. For arterial repair, the two arterial ends with low molecular weight heparin were rinsed, and then reattached . The limb was then immobilized in a plaster cast wrist splint in palmar flexion for three weeks. With this treatment antibiotic prophylaxis, serotherapy and analgesics were combined. Rehabilitation was started 21 days postoperative by active and passive movements. After follow-ups, PRWE's patient evaluation gave 0/50 for both pain and hand function.