Cross-limb vascular shunting for major limb replantation

In the management of traumatic major limb amputation, rapid re-establishment of circulation to the amputated part is imperative so as to prevent complications related to reperfusion injury, especially for those already suffering from prolonged ischemia. A temporary, extra-anatomic cross limb shunting with infusion lines can be used to perfuse the amputated part almost instantaneously. This allows the surgeon to carry out skeletal fixation and other reparative works in an unhurried manner. The cannulation site is targeted at intact vessels far away from the injury zone, obviating the need to explore and handle traumatized vessels at the mangled stump ends, thus greatly simplifying and expediting the revascularization process. Such a method had been successfully applied in 2 young people suffering traumatic arm amputation and thigh amputation, respectively. We suggested that such a procedure could be a useful adjunct in the field of major limb replantation.