Fig. 1

a: Amputated left hand of a 26 year old male at the level of the wrist preoperatively with a multilevel and avulsion injury through a plastic pellet machine. It shows additional subtotal amputation of the index finger and complete amputation of the middle- and ringfinger. The thumb was not injured; the little finger had a radial soft tissue defect. (PP) = black/white plastic pallets. (DRUJ) = distal radioular joint. (FT) = Flexor tendons. (M) = N. medianus. b: Preoperative situation of the stump of the distal forearm of the same 26 year old male. c: X-Rays of the left lower upper extremity and the left amputated amputated hand. (D1) = digit 1. (D5) = digit 5. The left picture shows a complete fracture of the distal radius and the distal ulna, with the distal radio ulnar joint lying transverse (DRUJ). The right picture shows the lower upper extremity with a fracture of the radius (R) and the ulna (U). d: Replanted hand postoperatively: thumb (D1) and little finger (D5) could be preserved, the index, middle and ringfinger were not re-plantable, the remaining defect (D) was temporarily covered by a negative pressure wound dressing and in a second operation 5 days later covered with split-skin-grafts. e: Replanted hand 9 months postoperatively: the patient is able to perform minimal flexion and adduction of the thumb in order to grip objects. f: X-Ray of the replanted hand 9 months postoperatively. (U) = ulna. (R) = radius. (RSL) = atypical RSL-arthrodesis of the left wrist