Integrated Multistage Approach to Bilateral Complex Functional Upper Limb Reconstruction in a Patient with Major Functional Impairment: Case Report

Turcu E. G.

Citation: Turcu E. G., "Integrated Multistage Approach to Bilateral Complex Functional Upper Limb Reconstruction in a Patient with Major Functional Impairment: Case Report", Universal Library of Medical and Health Sciences, Volume 03, Issue 04.

Copyright: This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

We present the case of a 68-year-old patient with catastrophic bilateral upper limb impairment. On the left side, the patient suffered a post-traumatic brachial plexus palsy after a scapulohumeral dislocation six months earlier, resulting in high radial nerve paralysis and low-level median and ulnar nerve dysfunction. On the right side, previous grade IV frostbite led to amputations at the metacarpophalangeal joints of digits II–V and at the first phalanx of the thumb. These combined injuries produced a severe functional handicap in both upper limbs, dramatically limiting the patient’s autonomy in daily living. A multistage reconstructive approach was carried out. The surgical plan included soft-tissue releases, tendon transfers, joint stabilization, and selective nerve decompression, tailored to the distinct pathology of each limb. This was followed by an intensive, structured rehabilitation program focused on neuromuscular re-education and progressive functional integration. Postoperatively, the patient achieved substantial improvements in motion, grasp strength, and overall autonomy. Functional restoration allowed significant social reintegration, highlighting that even in complex bilateral cases, individualized multilevel surgical reconstruction combined with rehabilitation can produce meaningful recovery.


Keywords: Brachial Plexus Palsy, Upper Limb Reconstruction, Nerve Paralysis, Amputation, Rehabilitation.

Download doi https://doi.org/10.70315/uloap.ulmhs.2025.0304006