Complete Middle Forearm Amputations After Avulsion Injuries—Microsurgical Replantation Results in Vietnamese Patients

Abstract

With respect to social and psychologic effects, performance of the procedure is extremely worthwhile because it not only provides complete limb preservation, but also has excellent potential for a favorable functional outcome.

Long-Term Outcomes of Major Upper Extremity Replantations

“…Considering all factors, unpredictable hospital stays and the variability of functional results have led to guarded optimism (31), although many authors continue to suggest that major upper extremity replantations are worthwhile (9,29,32). Further inquiry into the impact on health-related quality of life and the cost effectiveness of major upper extremity replantation will offer further insight into the overall effectiveness of these procedures (33).…”

Macroreplantations of the upper extremity: a series of 11 patients

“…Pre-and intraoperative cooling of the amputated part using ice packs and ice water in filled surgical gloves minimizes warm ischemia. When the amputation is more or less monotraumatic, a temporary shunting is usually performed to quickly revascularize the extremity [4,24]. If resuscitation of the patient makes a long replantation procedure unfeasible, temporary ectopic implantation of the amputated part to a healthy recipient, e.g.…”

“…Usually, bone shortening of the forearm by 5-8 cm is well tolerated. Bone stabilization is preferentially done by plate fixation or with Kirschner wire [4] depending on the localization of osteotomies. Intra-operative X-ray control is used to check the osteosynthesis.…”

“…Once the decision to replant has been made, patient safety becomes the prime concern. All indications for replantation must take into account the patient's general state of health, the ischemia time and the level, type and extent of tissue damage [3][4][5][6]. It should also be kept in mind that replantation is costly and requires prolonged operative time, long recovery periods, multiple procedures, and motivated patients to achieve optimal outcomes [7].…”

Complete major amputation of the upper extremity

“…10 Once the decision has been made in favor of replantation, the local infrastructure must provide experienced orthopedic, plastic/hand surgeons as well as experienced anesthesiologists and critical care support to deal with this type of procedures to increase the quality of the intraoperative/ postoperative care and ensure patient's safety. 6 Traumatic amputations of the upper extremity are less common than those of the lower extremity, but the literature reveals an increasing number of patients experiencing these injuries. 11 Because of the important function of the hand in daily living activities, replantation of amputated hands and forearms/arms has been considered to be an absolute indication if the patient's general status does not reflect a contraindication.…”