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Related Experiment Videos

Upper extremity replantation: current concepts and patient selection

A H Gold, G W Lee

    The Journal of Trauma
    |July 1, 1981
    PubMed
    Summary

    Replantation surgery for upper extremities has evolving criteria. Contraindications include life-threatening injuries and long warm ischemic times, while favorable factors include sharp amputations and proper part preservation.

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    Area of Science:

    • Reconstructive surgery
    • Microsurgery
    • Trauma surgery

    Background:

    • Advances in microsurgery and replantation techniques have refined patient selection for upper extremity replantation.
    • Established criteria guide surgical decisions, balancing potential benefits against risks.

    Observation:

    • Contraindications include life-threatening injuries, significant anesthetic risk, pre-existing medical/psychiatric conditions, and prior damage to the amputated part.
    • Optimal warm ischemic times are 6-8 hours for extremities and 10-12 hours for digits.
    • Single-digit amputations are generally not candidates, except for the thumb to preserve grasp function.

    Findings:

    • Replantation is feasible for sharp amputations, mild-to-moderate crush injuries, or selected avulsion injuries proximal to the distal interphalangeal (DIP) joint.

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  • Proper preservation of the amputated part, avoiding dry ice, is critical for successful outcomes.
  • The decision hinges on predicting superior functional outcomes compared to prosthetic use.

    • Implications:

    • Refined patient selection optimizes resource allocation in replantation surgery.
    • Understanding contraindications and favorable conditions improves surgical success rates.
    • This approach aims to maximize functional recovery and quality of life for patients with upper extremity amputations.