30 巻 (2017) 1 号 p. 32-37
A 53-year-old male received an electric saw injury, resulting in complete amputation at the level of the wrist. Replantation was successful, but hand stiffness remained ; consequently, several secondary surgeries were performed. After flexor tenolysis, flexor tendon rupture of the pinky finger occurred. Resection of the hook of hamate and tendon graft were performed. At the same time, an Ilizarov minifixator was attached to widen the first interdigital space. One year after replantation, a coler Doppler echocardiogram detected ruptures of the fourth and fifth extensor tendons ; subsequently, tenosuture and tendon transfer were performed. As a result, the following scores were achieved : the percentage of total active motion ( %TAM ) of all fingers, 66-80% ; Disabilities of Arm, Shoulder and Hand ( DASH ) score, 43.1 ; Chen grade scale, III ; and Tamai score, 61. Although the intrinsic muscles do not exhibit good function, the patient can tie strings and write letters. Several secondary surgeries and rehabilitation using a dynamic splint were important for achieving functional improvement in this case.