Successful Limb Replantation – A Case Study of Distal Forearm Amputation

Successful Limb Replantation – A Case Study of Distal Forearm Amputation

Muscles Severed During the Amputation Event

During the amputation, the Flexor carpi ulnaris, Flexor digitorum profundus, Flexor pollicis longus, Pronator quadratus, and Palmaris longus muscles were likely severed. These muscles are usually positioned in the distal segment of the forearm, and they are engaged in fingers and wrist flexion and are also responsible for forearm pronation.

Compromised Muscle Leading to Improper Pronation

If the patient were no longer able to properly pronate his arm, the muscle that may have been compromised is the pronator quadratus. This muscle plays a crucial role in pronating the forearm by rotating the radius over the ulna (Lung & Siwiec, 2019).

Metabolic Demands and Tissue Composition

Although the time frame for landing a successful refit for an amputated arm is shorter than the window for finger replantation surgery, the particular tissue composition of the arm may be different, as well as the possible metabolic demands. Limb muscles, cartilage, and bones all have higher metabolic activities than the fingers. This probably stems from the fact that there is greater muscle mass, more extensive vascularization, and an even higher weight of the limb compared to only the smaller fingers.

Tissue Type Bridging the Severed Muscle Bellies

The tissue type bridging the two halves of the once-severed muscle bellies is likely fibrous tissue. Muscles primarily grow through hypertrophy, which involves an increase in the size of existing muscle fibers rather than an increase in their number (hyperplasia). During the healing process following a muscle injury, fibrous tissue, also known as scar tissue, forms to bridge the gap between the severed muscle end fibers (Dydyk et al., 2020). This tissue provides structural support and facilitates the regeneration of muscle.

References

Dydyk, A. M., Negrete, G., & Cascella, M. (2020). Median Nerve Injury. PubMed; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK553109/

Lung, B. E., & Siwiec, R. M. (2019, February 10). Anatomy, Shoulder and Upper Limb, Forearm Flexor Carpi Ulnaris Muscle. Nih.gov; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK526051/

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A 19-year-old male patient’s arm was severed at the distal forearm while working with a machine in his workplace. Both the limb and the patient were brought to the ER. When the severed limb was examined, it was noted that the tissue only received minor crush injuries at the site of amputation (see Figure 1). After a long and arduous surgery reconnecting the muscles, nerves,s and blood supply the arm was replanted.

Successful Limb Replantation – A Case Study of Distal Forearm Amputation

After years of therapy, the patient’s limb was salvaged with most functionality and sensitivity returned. Although very satisfied that the limb wasn’t lost, the patient notes that the functionality hasn’t been the same. The deformities to the limb at the site of amputation are also notable (see Figure 2).

Instructions
Answer the following questions based on the scenario and article above and save your responses in a Microsoft Word document. Provide a scholarly resource in APA format to support your answers.

Name the muscles severed during the amputation event.
If the patient were no longer to properly pronate his arm, which muscle do you think has been compromised?
In general, a patient with a severed limb has a smaller window of time for successful replantation when compared with finger replantation surgery. This is in part due to the difference in tissue composition of the two anatomical structures. What does this say about the metabolic demands for muscles, cartilage, and bone? Why do you suppose that is?
What tissue type can be found bridging the two halves of the once-severed muscle bellies? Why? (Hint: How do muscles grow, hyperplasia or hypertrophy?)