A serious complication after forearm replantation caused by a cord tightened on the stump during transportation – a case report

In amputations of an upper extremity, an adequate preservation of the amputated part during its transport to a replantation centre is very important: it needs to be maintained at about 4°C. Providing adequate haemostasis of the extremity stump is also important for the patient’s safety, to avoid bleeding on the journey. The article presents the case of a patient who had sustained a hand amputation at the forearm, in which bleeding from the stump was stopped with a cord that has been tightened on the forearm, 10 cm above the amputation site. Transport for the patient took over 6 h and resulted in a critical ischaemia of the forearm stump. Replantation was successfully performed, but an excessive oedema of the ischaemically injured part of the stump developed in the post-operative course, requiring a fasciotomy, resection of the necrotic muscles, following by coverage of the defects with skin grafts. No complications were observed in the replanted part of the forearm, and the prognosis towards recovery of good hand function is moderate, due to the loss of a portion of the forearm muscles.