1. Identify at least five organ systems in this region of the arm that the surgeon would have marked for reattachment.When a traumatic amputation occurs, there is damage to five structures. The traumatic amputation in the case study occurred four inches above the eight-year-old elbow. The surgeon would have to attempt reattachment of integumentary muscles, cardiovascular nerves, and skeletal systems.
Another term for complete reattachment of the limb or appendage after traumatic amputation is replantation.2. List the names of the specific structures that had to be reattached.The names of the specific structures that need to be reattached. The specific bone structure for reattachment is the humerus. The specific muscle groups are the biceps brachii, triceps brachii, and the brachialis. The specific nerve structures are the musculocutaneous nerve, the radial nerve, ulnar nerve median nerve.
The specific blood vessels are the basilic vein, cephalic vein, brachial artery, superior ulnar collateral artery.
The specific integumentary are the epidermis, dermis, hypodermis.3. What organ system was most likely not reattached? Explain.The intricate nervous system was most likely not reattached. It is difficult to complete reattachment of the complicated network of the fine nerve fibers. The nervous system does not the same ability to regenerate like the other organ systems throughout the body.
The ability for nerve repair to happen is dependent on successful replantation. Ultimately, some use of the arm would be recovered but not pervious movements and abilities.4. Why was a clean bite so important?A complete amputation is defined as separation of appendage from the body. There are three types of traumatic amputation. The first type is avulsion, this is when the edges are ripped or jagged. Avulsion amputation are the most frequent and least successful types for replantation.
The second type is crush amputation, which has irregular edges and great tissue damage. Crush amputation makes replantation extremely difficult and usually ends up unsuccessful. The last type is guillotine amputation is least frequent type. Guillotine amputation has greater replantation success rates due to the clean edges. The lack of shredded tissue would make it easier to identify structures for realignment during replantation.5. Why was the bone shortened?The bone was shortened to allow for maximum bone to bone contact to occur.
Also, the shorten bone allows for best realignment of specific structures, and optimum wound closure. Damaged nerve and blood vessels would benefit from skeletal fixation and manipulation because it would keep these compromised structures from being stretched or damaged further in replantation.6. Identify the movements associated with the arm, forearm, wrist, and fingers.The movements that are associated with arm, forearm, wrist, and fingers are flexion, extension, abduction, adduction, grasping, mobility of individual fingers, hyperextension, supination, circumduction. Flexion is the movement of the joint or limb. Extension is the opposite of flexion so you extend the limb or joint to be straighten in the posterior direction.
Abduction is when moving the limb big or small away from midline of the body such as rising arm to the side or open fingers. Adduction is opposite of abduction, instead of pulling away from the midline you bring limbs towards the midline such as lowering your arms to the side or closing your hands. Supination is movement related to rotation of the forearm so that your palms are facing either forward or upward. Hyperextension is movement that is excessive past the normal, healthy range of motion of joint such snapping you head back, extending arm or leg. Circumduction is a movement of limb so the distal end moves around circle while proximal end remains in set position such doing windmills with your arms or wrist.7. Explain how the movements of the reattached arm might be altered after the reattachment.
One way of classifying results of major upper extremity replantation is called Chen’s system. Chen’s system classifying the results into four different grades which are based on the analysis of four parameters: the ability to work, range of motion, recovery of sensibility, and muscle power. Chen’s grade system ranges from one to four, which are classified based on patient’s performance with that reattached limb.8. Define collateral circulation and identify the regions of collateral circulation that would be found in the upper extremity. Vascular channels from interconnections. These arterial channels form branches, these branches give blood to most organs and tissues.
Where these atrial branches merge. They are called arterial anastomose. The arterial anastomoses create collateral channels also known as collateral circulation. Collateral circulation is an alternate pathway of circulation for blood to tissues and organs.9. Identify the specific vessels that provide the collateral circulation to the elbow.10.
Identify specific types of activities that might cause Jim problems after recovery.11. Why would full use of his arm be unlikely?12. Assume the role of the surgeons as they explain the procedure to Jim’s parents. Write a one- to two-page explanation about the surgery, paying particular attention to what you would say about regaining use of his arm, forearm, and hand.The surgeon would reinforce the preservation and recovery of the severed limb was integral in successful reattachment. The surgeon would also address that Jim was eight-year-old male which greatly increased the chances of successful replantation.
Children are best candidate for reattachment. A child’s healing capacity is unmatched due to their potential for nerve regeneration, rapid bone healing, and sensory self-reeducation. Explanation of the positive aspects of the Guillotine amputation would address. Details of the need for minimal debridement, clean edges, and increased chances of survival of the limb. It would explain that replantation starts from the inside out. The skeletal fixation happens first by shortening the bone and placing a plate to stabilize. Next, vascular repairs are done to restore circulation.
Later, this is followed by nerve repair, which is primary dependent on successful plantation of the other systems. Finally, this will be followed by partial or complete wound closure.13. Assume the surgery to reconnect blood vessels was successful and blood flow was re-established immediately throughout the arm. Would the nerves of the arm recover as quickly and completely as the muscles? Explain why or why not.14. How might this situation have been different if Jim had been 80 instead of 8 years old?
