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Institution: Department of Plastic Surgery, Gothenburg University , Sweden - Västergotland, Sweden
During Midsummer 1979, at the first Microsurgery Centre in Sweden, we were faced with a difficult replantation case. A young boy with a multilevel sharp amputation from a hay cutting machine with complete amputation of his hand. Replantation was carried out with multilevel repairs of neurovascular and skeletal structures. Initial success was achieved but subsequently reoperations were required for microvascular revision. Eventually we saved the forearm to the wrist joint level but the hand was lost. The boy was fitted with a myoelectrical prosthesis.
The question was could we have performed better?
1983/84 Slovenian microsurgeon Marko Godina implemented the new principle of Temporary Ectopic Implantation (TEI) in two cases, with revplantation of fingers and the hand. The fingers were implanted in the groin, but anastomoses ruptured from hip movement. The groin proved unfavorable. Next, an amputated hand similar to ours, the Temporary Ectopic Implantation (TEI) at the axilla. This was successful and finally the hand was replanted orthotopically later.
One of our most ingenious colleagues had introduced a new controversial, principle in surgical trauma. Marko Godina tragically died in a traffic accident February 1986, but his manuscripts of Sept 1986 were published in the American journal PRS .
Well after our experience, “Damage Control” became an important concept in major trauma, with motto: “Let the patient live to fight another day!” The parallel in microsurgery is “Let amputate survive by ectopic implantation for later replantation!”
The principles of TEI which could have applied if known back in 1979 are discussed.
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Authors
Dr Richard Hamilton - , Assoc Prof Ingemar Fogdestam -