{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,8,28]],"date-time":"2025-08-28T12:24:46Z","timestamp":1756383886930,"version":"3.44.0"},"reference-count":19,"publisher":"BMJ","issue":"3","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2021,1,23]]},"published-print":{"date-parts":[[2021,3]]},"abstract":"<jats:p>Amputations of the upper limb, in particular, have a major impact on patients\u2019 lives, as loss of function can not only cause reduced autonomy in daily life but also hinder social interactions and capacity for work. Replantation at or proximal to the wrist, referred to as wrist-proximal replantation, remains a daunting challenge that presents the hand surgeon with an array of difficulties distinct from digital replantation.We present our experience with a successful replantation of a near-complete amputation at the non-dominant left wrist in a 25-year-old man managed in sub-Saharan Africa. Two years after replantation, the patient had a Disabilities of the Arm, Shoulder and Hand score of 40 and 2-point discrimination of 6 mm. We also discuss the peculiar challenges which have limited the development of replantation in the tropics. Environmental temperatures, manpower, expertise and technology are possible factors that limit this practice in the tropics.<\/jats:p>","DOI":"10.1136\/bcr-2020-238393","type":"journal-article","created":{"date-parts":[[2021,3,2]],"date-time":"2021-03-02T10:56:52Z","timestamp":1614682612000},"page":"e238393","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":1,"title":["Replantation of amputation at the wrist: challenges of management in sub-Saharan Africa"],"prefix":"10.1136","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0472-7894","authenticated-orcid":false,"given":"Chidiebere Peter","family":"Echieh","sequence":"first","affiliation":[{"name":"Department of Surgery, University of Calabar, Calabar, Cross River, Nigeria"},{"name":"Department of Surgery, University of Calabar Teaching Hospital, Calabar, Cross River, Nigeria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mba","family":"Ozinko","sequence":"additional","affiliation":[{"name":"Department of Surgery, University of Calabar, Calabar, Cross River, Nigeria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Benjamin Irene","family":"Omoregbee","sequence":"additional","affiliation":[{"name":"Department of Cardiothoracic Surgery, Castle Hill Hospital, Hull University Teaching Hospital NHS, Kingston-Upon-Hull, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kelechi Emmanuel","family":"Okonta","sequence":"additional","affiliation":[{"name":"Department of Surgery, University of PortHarcourt, PortHarcourt, Rivers State, Nigeria"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2021,3,2]]},"reference":[{"key":"2025082709122142000_14.3.e238393.1","doi-asserted-by":"publisher","DOI":"10.1097\/00006534-200103000-00027"},{"key":"2025082709122142000_14.3.e238393.2","doi-asserted-by":"publisher","DOI":"10.1016\/j.hcl.2007.01.001"},{"key":"2025082709122142000_14.3.e238393.3","doi-asserted-by":"publisher","DOI":"10.1001\/jama.1964.03070100010002"},{"key":"2025082709122142000_14.3.e238393.4","doi-asserted-by":"crossref","DOI":"10.1186\/s12891-017-1442-3","article-title":"Long-Term outcome following upper extremity Replantation after major traumatic amputation","volume":"18","author":"Mattiassich","year":"2017","journal-title":"BMC Musculoskelet Disord"},{"key":"2025082709122142000_14.3.e238393.5","doi-asserted-by":"crossref","first-page":"e227955","DOI":"10.1136\/bcr-2018-227955","article-title":"Forearm Replantation after traumatic complete amputation","volume":"11","author":"Yoshida","year":"2018","journal-title":"BMJ Case Rep"},{"key":"2025082709122142000_14.3.e238393.6","doi-asserted-by":"publisher","DOI":"10.1016\/j.hcl.2006.12.001"},{"key":"2025082709122142000_14.3.e238393.7","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhsa.2011.03.039"},{"key":"2025082709122142000_14.3.e238393.8","doi-asserted-by":"publisher","DOI":"10.1016\/0007-1226(80)90006-5"},{"key":"2025082709122142000_14.3.e238393.9","doi-asserted-by":"crossref","first-page":"35","DOI":"10.4103\/1117-6806.127108","article-title":"Early experiences with microvascular free tissue transfer in Lagos, Nigeria","volume":"20","author":"Mofikoya","year":"2014","journal-title":"Niger J Surg"},{"key":"2025082709122142000_14.3.e238393.10","doi-asserted-by":"publisher","DOI":"10.1016\/j.bjps.2007.02.017"},{"key":"2025082709122142000_14.3.e238393.11","doi-asserted-by":"publisher","DOI":"10.1682\/JRRD.2007.09.0151"},{"key":"2025082709122142000_14.3.e238393.12","doi-asserted-by":"publisher","DOI":"10.1016\/S0363-5023(84)80186-0"},{"key":"2025082709122142000_14.3.e238393.13","doi-asserted-by":"publisher","DOI":"10.1097\/00006534-198610000-00017"},{"key":"2025082709122142000_14.3.e238393.14","unstructured":"ed, Gravlee GP , Davis RF , Stammers AH . 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