Upper extremity replantation at a regional medical center: a six-year review

Trauma to the upper extremity can be a cause of significant morbidity and disability to otherwise productive people. Traumatic amputation can be particularly devastating, but many of these extremities can be saved by replanatation of the amputated parts. We reviewed the upper extremity replantations performed at the Medical Center of Central Georgia in the 6-year period from September 1987 to August 1993. A total of 48 replantations in 39 patients (33 male, six female) were studied: 36 fingers, seven thumbs, two transmetacarpals, one wrist, one forearm, and one brachium. Average patient age was 32.7 years, with a range of 4 to 69 years. All seven thumbs, two transmetacarpals, and three proximal replants survived. Viability of replanted fingers was 56 per cent; however, sharp injuries fared better than crush injuries (62% vs 50%). The success rate improved with experience of the surgeon (85% after 1990). Leeches were used effectively for venous congestion in nine of 13 cases (70%). Results were comparable with those of large academic medical institutions. Replantation of traumatic amputations can be performed with reasonable success at a regional medical center if a qualified surgeon and appropriate ancillary care are available. Results improve with experience of the surgeon and careful patient selection. Successful replantation significantly reduces the morbidity of upper extremity amputations and will continue to be important in the management of the trauma patient.