Hand, Wrist, Forearm, and Arm Replantation

Area of Science:

• Orthopedic Surgery
• Microsurgery
• Reconstructive Surgery

Background:

• Level of injury significantly impacts replantation success.
• Distal injuries (forearm/wrist) offer better functional outcomes than proximal ones.
• Patient-specific factors are critical in determining candidacy for replantation.

Purpose of the Study:

• To analyze the factors influencing replantation decisions and outcomes.
• To highlight the importance of injury level and patient selection.
• To discuss the surgical principles and expected outcomes of upper extremity replantation.

Main Methods:

• Review of clinical decision-making in upper extremity replantation.
• Analysis of functional outcomes, nerve regeneration, and reperfusion injury based on injury level.
• Consideration of patient comorbidities, expectations, and safety in candidacy assessment.
• Surgical preparation including vascular grafting and contralateral limb availability.

Main Results:

• Improved functional outcomes, nerve regeneration, and reduced reperfusion injury observed in distal forearm/wrist injuries.
• Vascular grafts are frequently required, necessitating preparation of adjacent or contralateral limbs.
• Despite potential functional deficits, high patient satisfaction and independence are achieved post-replantation.

Conclusions:

• Injury level is a key determinant for successful upper extremity replantation.
• Careful patient selection based on medical condition and expectations is paramount.
• Major upper extremity replantation can restore significant function and independence, even with diminished outcomes.