J Hand Microsurg 2009; 01(02): 63-67
DOI: 10.1007/s12593-009-0017-4
Original Article
Thieme Medical and Scientific Publishers Private Ltd.

Major upper extremity replantations

B. Yaffe
,
D. Hutt
,
Y. Yaniv
,
J. Engel

Subject Editor:
Further Information

Publication History

19 February 2009

08 May 2009

Publication Date:
05 September 2016 (online)

Abstract

The usual mechanism of a major amputation creates a mutilating injury. Although survival rate is high, the functional results are guarded [1, 2]. The aim of this study is to review our experience with major upper extremity replantations performed between the years 1987–2007 with respect to the type of amputation as proposed by Chuang et al. [3]. 23 upper extremities were replanted in 22 patients (7 arms and 16 proximal forearms and elbows). All but one replanted parts survived. Out of 6 patients with arm replants 4 gained useful extremities and two had poor result after more than 2 years of rehabilitation and 17 additional surgical procedures. Out of 16 replanted forearms, after more than 2 years of rehabilitation period and 50 operations, useful extremity was achieved in 11 and poor result in 5. The main factor influencing functional result was the type of amputation according to Chuang et al. [3].

 
  • References

  • 1 Wood MB, Cooney WP. Above elbow limb replantation: Functional results. J Hand Surg [Am] 1986; 11: 682-687
  • 2 Atzei A, Pignatti M, Maria Baldrighi C et al Longterm results of replantation of the proximal forearm following avulsion amputation. Microsurgery 2005; 25 ((4)) 293-298
  • 3 Chuang DC, Lai LB, Jain V et al Traction avulsion amputation of the major upper limb: a proposed new classification, guidelines for acute management, and strategies for secondary reconstruction. Plast Reconstr Surg 2001; 108 ((6)) 1624-1638
  • 4 Chuang DCC. Functioning muscle transplantation for the upper extremity. Hand Clin 1997; 13: 279-289
  • 5 Chuang DCC, Strauch RJ, Wei FC. Technical considerations in two-stage functioning free muscle transplantation reconstruction of both flexor and extensor functions of the forearm. Microsurgery 1994; 15: 338-343
  • 6 Graham B, Adkins P, Tsai TM et al Major replantation versus revision amputation and prosthetic fitting in the upper extremity: A late functional outcomes study. J Hand Surg [Br] 1998; 23: 783-791
  • 7 Blaisdell FW. The pathophysiology of skeletal muscle ischemia and the reperfusion syndrome: a review. Car-diovasc Surg 2002; 10 ((6)) 620-630
  • 8 Waikakul S, Vanadurongwan V, Unnanuntana A. Prognostic factors for major limb re-implantation at both immediate and long- term follow-up.. J Bone Joint Surg Br 1998; 80-B: 1024-1030
  • 9 Chen ZW, Meyer VE, Kleinert HE, Beasley RW. Present indications and contraindications for replantations as reflected by long- term functional results. Orthop Clin North Am 1981; 12: 849-870
  • 10 Schoeller T, Wechselberger G, Hussl H, Huemer GM. Functional transposition of the latissimus dorsi muscle for biceps reconstruction after upper arm replantation. J Plast. Reconst. Aesthetic Surg 2007; 60: 755-759