Secondary operations after replantation

104 secondary operations after 76 successful replantations in the upper limb in 49 patients have been evaluated. Of 150 successful replantations in 106 patients this represents an incidence of secondary procedures of 50.6%. 28.5% for skin cover, 18.6% on nerves, 17.6% on joints, 7.4% on bones and 3.9% on vessels. 1.5% of secondary operations were for removal of materials used for bone fixation. The most frequent operations on the individual structures in relation to level of amputation and the interval after replantation have been described. The inference that the number of reconstructed vessels influences the number of secondary operations can at least be drawn from the figures for skin cover for the finger as a whole, but not for the other structures. From the metacarpus proximally, no relationship could be demonstrated between vessels anastomosed and secondary procedures. An association between type of injury and incidence of secondary operations could be demonstrated. The so-called "unfavourable" slicing injuries. It was remarkable that circular saw and crush injuries, usually regarded as "unfavourable", necessitated fewer further operations than slicing injuries. Equally unexpected was the finding that secondary operations were most frequent not in the oldest age groups but in the group aged between 10 and 20. The type of injury can be excluded as a reason for this. No satisfactory explanation can be given.