Outcomes of simultaneous microsurgical replantation of complete amputations at the distal third of the right forearm and left wrist: a case report and 22-month follow-up

Microsurgical replantation of simultaneous bilateral upper extremity amputations is a complex procedure requiring a highly coordinated multidisciplinary team. Functional outcomes depend on anatomical level of injury, duration of ischemia, extent of crushing, degree of contamination, and quality of postoperative rehabilitation. We report a 45-year-old male industrial worker who sustained complete simultaneous amputations through the distal third of the right forearm and at the left wrist following an industrial paper-cutting machine accident. Total ischemia time was 8 hours. Two microsurgical teams performed simultaneous replantation including radical debridement, bone shortening and stable fixation (dual plates on the right; volar locking plate plus K-wire on the left), repair of all flexor and extensor tendons, microneurorrhaphy of the median, ulnar and radial nerves, and arterial plus venous anastomoses. Both limbs survived without complications. At 22-month follow-up, active wrist flexion–extension was 80°–0°–90° on the right and 60°–0°–90° on the left. Motor strength was M4 and protective sensation was S3 bilaterally. Electromyography confirmed complete median nerve reinnervation. The patient could ride a motorcycle using both hands and independently lift a 10 kg water container. This case demonstrates that simultaneous bilateral replantation with 8-hour ischemia can achieve functionally useful recovery at the wrist and distal forearm levels when performed with meticulous technique and supported by early intensive rehabilitation. Prolonged ischemia is not an absolute contraindication for replantation at these levels in appropriately selected young patients with sharp injuries.