[Subtotal and total traumatic extremity amputation--when replantation, when amputation?]

The major problems besetting replantation of a limb are the very limited tolerance of muscle tissue to ischemia (in our experiences 5 h) and the possibility of severe postischemic complications either in the limb itself (capillary thrombosis, muscle necrosis) or systemically (kidney failure, speticemia). Between 1975 and 1988, 66 limb replantations (57 arms, 9 legs) were carried out. All nine legs had to be reamputated. Forty-five of the 57 reattached upper extremities (80%) healed without any major complications, 60% exhibited good or very good results (Grade II or I, Classification by Chen).