Traumatic Amputation of the Upper Limb

D'Addato, M; Pedrini, L; M, Bertoni; Stella, Andréa; Vitacchiano, G; Sardella, Leonardo; Ciuccarelli, C; Maggi, G.; Poppi, Massimo

doi:10.1097/00005373-198906000-00029

Cited by 12 publications

(5 citation statements)

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“…In the early years, the main concern was for the replant to remain viable. 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 ].…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2015

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BackgroundTraumatic arm amputations can be treated with replantation or surgical formalization of the stump with or without subsequent prosthetic fitting. In the literature, many authors suggest the superiority of replantation. This systematic review compared available literature to analyze whether replantation is functionally and psychologically more profitable than formalization and prosthetic fitting in patients with traumatic arm amputation.MethodsFunctional outcome and satisfaction levels were recorded of patients with amputation levels below elbow, through elbow, and above elbow.ResultsFunctional outcomes of 301 replantation patients and 172 prosthesis patients were obtained. In the replantation group, good or excellent functional scores were reported in 39% of above elbow, 55% of through elbow, and 50% of below elbow amputation cases. Nearly 100% of patients were satisfied with the replanted limb. In the prosthesis group, full use of the prosthesis was attained in 48% of above elbow and in 89% of below elbow amputation patients. Here, 29% of patients elected not to use the prosthesis for reasons including pain and functional superfluity. In both replantation patients and prosthesis wearers, a below elbow amputation yielded better functional results than higher amputation levels.ConclusionsReplantation of a traumatically amputated arm leads to good function and higher satisfaction rates than a prosthesis, regardless of the objective functional outcome. Sensation and psychological well-being seem the two major advantages of replantation over a prosthesis. The current review of the available literature shows that in carefully selected cases replantation could be the preferred option of treatment.

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Section: Introductionmentioning

confidence: 99%

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

et al. 2015

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“…Several authors have described the sequential technique of venous flow clamping and release from the partially replanted limb for a period of 10 to 20 minutes to reduce the systemic ingress of toxins from the damaged ischemic tissues. [14][15][16] Arterial flow to the limb was maintained during this period and venous drainage was facilitated by allowing bleeding from unanastomosed veins. We allowed an average of 5 minutes of venous bleed egress from the unanastomosed vein.…”

Section: Discussionmentioning

confidence: 99%

Perioperative Evaluation and Outcomes of Major Limb Replantations with Ischemia Periods of More Than 6 Hours

Tantry

Kadam

Shenoy

et al. 2013

J reconstr Microsurg

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Early revascularization is cardinal for successful replantation of proximal limb amputations. Prolonged ischemia time potentially leads to reperfusion syndrome and morbidity. The dilemma persists regarding safe duration of cold ischemia time for replantation. The study was conducted to evaluate retrospectively the outcomes of major replantation in terms of limb survival, reperfusion events, morbidity, and potential mortality with respect to the ischemia time and level of amputations. Fourteen patients with proximal amputations at the arm, elbow, and forearm with total ischemia time beyond 6 hours were replanted. All had warm ischemia time of less than 2 hours and were closely monitored to record and correct reperfusion events. Nine out of 14 limbs survived. Five patients had reperfusion events. Proximal limb amputations with larger muscle mass were at higher risk of developing reperfusion syndrome and such events had higher chances of limb loss. Major limb amputations within 2 hours of warm ischemia time even with prolonged cold ischemia can be successfully replanted with closed perioperative monitoring.

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“…A partial reimplantation of spared tissues can help reconstruct the stump. [2][3][4] Differences between upper and lower extremities must be kept in mind. Serious complications are mainly related to the volume of muscle tissue of the reimplanted segment; as muscle volume in the upper extremities is less, the risk of reperfusion syndrome is lower.…”

Section: Discussionmentioning

confidence: 99%

“…A partial reimplantation of spared tissues can help reconstruct the stump. 2–4…”

Section: Discussionmentioning

confidence: 99%

Role of Temporary Arterial Shunt in the Reimplantation of a Traumatic Above-Elbow Amputation

et al. 2007

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Although the feasibility of reimplantation has increased greatly with the development of new surgical techniques, long-term functional prognosis is unpredictable. Injury to a major nerve is an important factor in long-term outcome, and prolonged ischemia time also has a negative effect. We present a 26-year-old woman whose right arm was sectioned above the elbow in an accident. The limb presented a complete section, with soft tissue loss of the humeral artery and vein, basilic vein, and cephalic vein. Median and radial nerve tissue was missing, and a supracondylar fracture with substantial loss of the humerus was also observed. During reimplantation surgery, a temporary arterial shunt reduced ischemia time. A venous and arterial bypass was performed, and the 12-month results were good.

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Traumatic Amputation of the Upper Limb

Cited by 12 publications

References 0 publications

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

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

Perioperative Evaluation and Outcomes of Major Limb Replantations with Ischemia Periods of More Than 6 Hours

Role of Temporary Arterial Shunt in the Reimplantation of a Traumatic Above-Elbow Amputation

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