Amputation of the hand is a rare and extremely intense trauma. Replanting and allografting after this type of injury require a major reorganization of the brain. Brain plasticity, though better known in the context of disorders of the central nervous system, is just as indispensable when the extremities are damaged.
A 17-year-old patient underwent replantation of the nondominant hand after transmetaphyseal amputation after traumatic injury. After 18 days in hospital and subsequent treatment in a physical rehabilitation center, the patient attended clinical and radiology follow-up sessions over the next 2 years.
The management of this patient led to an excellent functional outcome in conjunction with successful social and professional reintegration. Electromyography at 18 months confirmed nerve regrowth. Functional magnetic resonance imaging was done at 2 years to evaluate cerebral plasticity. Motor function, largely dependent on the primary motor area, is aided by the addition of secondary and accessory motor areas for both simple and complex movements. A change in sensory information is stimulation in its own right hemisphere and increases solicitation of the contralateral precentral and postcentral gyrus.
There seems to be a real reversible dynamic plasticity under the balance of inhibitory and excitatory influences exerted on the cortical neurons. Any disruption of this balance requires the brain to adapt to the new circumstances to reestablish the hand as a functioning part of the body.
From the *Department of Plastic Reconstructive and Hand Surgery, Department of Oral and Maxillofacial Surgery
†Department of Clinical Neurophysiology
‡Department of Radiology, University Hospital of Dijon
§Department of Neurology and Dijon Stroke Registry, University Hospital and Medical School of Dijon, University of Bourgogne Franche-Comté, Dijon, France.
Received December 11, 2018, and accepted for publication, after revision March 4, 2019.
Conflict of interest and sources of funding: none declared.
Reprints: David Guillier, MD, Department of Plastic Reconstructive and Hand Surgery, Department of Oral and Maxillofacial Surgery, Dijon University Hospital, Boulevard de Lattre de Tassigny, F-21000 Dijon, France. E-mail: firstname.lastname@example.org.
Online date: June 6, 2019