Major limb replantation: Current status and perspectives.

Area of Science:

• Microsurgery
• Trauma Surgery
• Reconstructive Surgery

Background:

• Major limb replantation aims to restore form and function after traumatic amputation.
• Outcomes are limited by ischemia, infection, and reconstruction complexity.
• Emerging strategies may expand indications and improve results.

Purpose of the Study:

• To conduct a scoping review of major limb replantation outcomes.
• To identify factors influencing replantation success and failure.
• To highlight areas for future advancement in limb salvage.

Main Methods:

• Scoping review of MEDLINE, Embase, and Cochrane Library databases.
• Inclusion of adult case series and reports from inception to December 2024.
• Exclusion of pediatric cases and long-term follow-up studies.

Main Results:

• Analysis of 99 publications reporting on 1107 patients with traumatic amputations.
• Overall replantation success rate of 68%, varying by amputation type (sharp 85%, crush 45%, avulsion 55%).
• Common failure causes include vascular complications, infection, and systemic inflammatory response.

Conclusions:

• Limb replantation success is constrained by ischemia-reperfusion injury and surgical complexity.
• New preservation techniques and perioperative care show potential for improved viability.
• Multidisciplinary advancements are essential for better outcomes in trauma care.