Secondary reconstructive surgery following major upper extremity replantation

Area of Science:

• Orthopedic Surgery
• Reconstructive Microsurgery

Background:

• Limited literature exists on reconstructive strategies post-upper extremity replantation.
• Successful replantation outcomes depend on appropriate secondary reconstructive procedures.

Purpose of the Study:

• To investigate the predictability of secondary reconstructive surgery based on amputation level and injury mechanism.
• To establish patterns in reconstructive procedures following successful upper extremity replantation.

Main Methods:

• Retrospective review of upper extremity replantations (2003-2012).
• Analysis of patient, injury, and surgical demographics.
• Documentation of replantation survival rates and secondary surgical procedures.

Main Results:

• 89% survival rate in 45 replantations.
• Average of three secondary procedures per patient (range: 0-7).
• Common procedures: soft-tissue coverage (24), tenolysis (24), free functioning muscle transfer (18), tendon transfer (14).

Conclusions:

• Secondary surgery type is predictable based on amputation level.
• Proximal amputations: soft-tissue coverage. Elbow/proximal forearm: free functioning muscle transfer. Distal forearm/wrist: tenolysis.