Abstract book - ESPRAS

L11. Replantation
Prof. Aurelio Portincasa
Plastic and Reconstrucive Surgery Department
University of Foggia, Foggia (Italy)
Definitions:
Replantation: if a part is completely amputated, i.e. cut off without any
attaching structures (vessels, nerves, tendons, bone) whatsoever, it will
be replanted
Revascularization: if a part has been deprived of its main blood supply,
but there are connecting structures remaining, such as tendon or nerve, the
part has been incompletely amputated and will be revascularized i .
Currently the ultimate success of a replantation attempt is judged by
functional as well as cosmetic parameters.Meyer ii state that patients with
amputations proximal to the wrist joint but close to it are good candidates
for replantation, as evidenced by Chen Grade I or II recovery in 80%.In
general, upper extremities amputated proximal to the midforearm should
not be replanted if the warm ischemia time exceeds 6 hours. The
following are universal contraindications to replantation:
- concomitant life-threatening injury
- multiple segmental injuries in the amputated part
- severe crushing or avulsion of the tissues
- extreme contamination
- inhibiting systemic illness (small vessel disease,
diabetes mellitus, etc)
- prior surgery or trauma to the amputated part precluding replantation
Return of function in forearm replantations depends largely on two factors:
(a) the degree of nerve regeneration, and
(b) the hand rehabilitation program iii .
The most frequent complications in upper limb replantation and
revascularization are: infection (30%); inadequate debridement;
nonunion and intrinsic muscle function weak or absent.
Excellent or good results are noted in patients with clean, guillotine-type
distal amputations or incomplete proximal amputations with intact nerves.
Fair and poor results are associated with crush or avulsion injuries. The
potential for functional recovery is directly proportional to the amount of
viable tissue remaining iv v .
In the hand, all other criteria being favorable few surgeons would argue
against replantation in the following circumstances:
- multiple finger amputations
- thumb amputations
- complete amputations of the hand at the palm or wrist
- all amputations in children
Replantation is still controversial in the following clinical situations:
- loss of a single digit other than the thumb, especially the index
and digitorum superficialis (FDS) tendon insertion
- single-digit amputations distal to the FDS insertion
- ring finger avulsion injuries
Other contraindications to replantation have been listed above.