[Long-term (33 years) result of revascularization of subtotally amputated upper arm]. / 33-letni wynik rewaskularyzacji prawie calkowicie amputowanego ramienia.

Replantations and revascularizations on the level of the arm are performed in the smallest number. The achieved functional results are poor. The paper presents a result achieved in a patient who sustained an avulsion amputation of an upper arm in the year 1974. The first long-term control was made 11 years after the revascularization of the limb which rated the result as III acc. to Chen's score system. The patient was steadily highly motivated for hand rehabilitation process. The second control performed 33 years after the accident proved the increase of sensibility, muscle strength as well as the range of movements. The result was up-graded as II (good). No degenerative changes in hand bones of mutilated hand were found.

Modified Colzi method in the management of established Volkmann contracture--the experience of Trzebnica Limb Replantation Center (preliminary report).

BACKGROUND: "The terrible disability of irreversible ischaemic flexion contracture of the metacarpi and digits known as Volkmann's contracture can be avoided in the vast majority of cases, but never completely cured" (M. Koszla). A modification of Colzi's forgotten technique for the treatment of Volkmann's contracture is presented together with our treatment outcomes. MATERIAL AND METHOD: The Colzi procedure was performed in 15 patients aged: 3-54 years with Buck-Gramcko grade III, III/IV and IV Volkmann's contractures. Time between injury and surgery ranged from 4.5 months to 21 years. The main manoeuvre to reduce the contracture was two-level shortening osteotomy in the proximal and distal thirds of the radius and ulna. Osteosynthesis was performed by Rush intramedullary nailing. RESULTS AND CONCLUSIONS: A very good range of mobility (from 17 degrees preop. to 56 degrees postop.), force (0.73 preop.- 7.6 kg postop.) and contracture correction (183 degrees preop. - 27 degrees postop.) was achieved. Complications in the form of delayed union or secondary fractures occurred in 4/15 patients, and were managed by prolonged immobilisation and decortication with bone grafting. The modified Colzi procedure proved its value as a universal, easy, minimally invasive and safe method of treatment of Volkmann's contracture regardless of patient age, duration of illness, previous therapy, and stage of contracture.

[The problems in replantation of limbs amputated through the arm region]. / Problemy replantacji konczyn amputowanych na poziomie ramienia.

The problems in replantation of arms were analysed on the ground of nine such replantations performed in Center of Replantations of Limbs in Trzebnica in the same number of patients (7 men, 2 children, 1 woman) during the seven year period 1993-2000. The range of age of the patients was from 12 to 62 years (35.5 on average). Among the problems discussed were such as qualification for the operation, operative technique (limb shortening, perfusion of vessels, half-open anastomosis of veins, neurotisation of remaining nerves) evaluation scale. Eight of the amputations were the results of crush-avulsion mechanism, one was guillotine-type. The patients required 15 secondary operations; all of them were able to perform an arm abduction and active flexion of the elbow joint. They all had at least protective sensibility on the palm. The results were rated (acc. to Chen-Yu scale) III(o)--four patients, IV(o)--four patients (one patient did not appear for control check-up). Despite of such a poor evaluation, all of the patients are satisfied with the operation.

[Replantation of both amputated shanks in a child--13 years of observations]. / Replantacja obu amputowanych goleni u dziecka--13 lat obserwacji.

The case of a patient aged 16 is presented who had 13 years ago both of her shanks amputated by a harvester and successfully replanted. The total ischaemia time was 11 hours. The replantation was simultaneously performed by two teams. Only one main artery (posterior tibial a.) and vein were anastomosed, as well as one nerve (posterior tibial n.). The late result was qualified as grade I according to Chen's assessment scale. The patient can walk without limping on any surface using ordinary shoes, being able to crouch and stand on the toes. Two-point--discrimination test taken on big toes was 15 and 17 mm. The case confirms a commonly shared opinion about positive results of replantations in children. The replantations should be performed exclusively in the specialised centres having at their command more then one of the replantation team.