Major limb, hand, and digital replantation

Abstract

Successful replantation of an amputated extremity depends mainly upon the accurate repair of blood vessels, but the final goal must be complete restoration of function. Before a decision to replant is made, the extent of tissue damage, the patient's age and general condition, sex, occupation, and the patient's wishes regarding replantation are evaluated. All tissues that influence survival of the replanted part and its ultimate function must be repaired primarily. An operating microscope should always be used for the vascular and nerve repairs, especially in digital replantation. Good postoperative management is the final key for successful replantation, and includes prevention of thrombosis and adequate rehabilitation. Systemic heparinization is used in digital replantation, but is not used in major limb replantation. Rehabilitation is begun on the first postoperative day, but several reconstructive operations may be necessary on the replanted part to achieve improved function.Between May, 1959 and December, 1977, replantation operations were performed in 218 extremities of 159 patients. Thirteen of 16 major limb replantations and 181 of 204 digital replantations have survived, an overall success rate of 88%. Functional recovery has varied in each individual for several reasons, but most patients are satisfied with the function of their replanted part.Replantation of amputated extremities was a matter of interest long before the standard of medicine had reached its present level. Paintings of limb replantation or transplantation were done by the Italian artist Tiepolo in the 17th century. Hoephner [1], one of

Replantation versus Prosthetic Fitting in Traumatic Arm Amputations: A Systematic Review

“…After title/abstract screening, 969 articles were excluded for the aforementioned reasons, leading to a total of 63 articles eligible for full-text screening. Of those, 39 were included for data extraction: 34 for replantation and 7 for prosthesis ( Fig 1 ) [ 2 , 5 – 11 , 13 , 15 – 44 ]. Attempts to contact the author for any missing data on individual results were made in five instances.…”

“…With improved (micro)surgical techniques and instrumentation, replantation has become a technically reliable procedure [ 3 , 4 ]. Presently, the concern has shifted towards obtaining satisfactory functional recovery with an acceptable cosmetic result [ 5 – 11 ].…”

Simultaneous Replantation of Both Lower Legs in a Child: 23 Years Later

“…with upper extremities. 3,6 Therefore, restoration of sensation, as well as motor function of intrinsic muscles of the foot, is less favorable in lower-extremity replantations. However, the functional tasks of the intrinsic muscles of the foot are much less sophisticated compared with the hand, and as long as the patient has protective plantar sensation in the foot and is able to walk without pain, the functional outcome of replantation may be considered satisfactory.…”

“…That is why many surgeons were rather skeptical about lower-limb replantations and did not consider them indicated. [1][2][3] Although cases of lower-extremity replantations have been reported, [4][5][6][7][8] there is a deficiency in the analysis of long-term results in the literature. Cases of simultaneous replantation of both lower legs are extremely rare, and only a few such cases have been reported in the literature.…”