Abstract
Early revascularization is cardinal for successful replantation of proximal limb amputations.
Prolonged ischemia time potentially leads to reperfusion syndrome and morbidity. The
dilemma persists regarding safe duration of cold ischemia time for replantation. The
study was conducted to evaluate retrospectively the outcomes of major replantation
in terms of limb survival, reperfusion events, morbidity, and potential mortality
with respect to the ischemia time and level of amputations. Fourteen patients with
proximal amputations at the arm, elbow, and forearm with total ischemia time beyond
6 hours were replanted. All had warm ischemia time of less than 2 hours and were closely
monitored to record and correct reperfusion events. Nine out of 14 limbs survived.
Five patients had reperfusion events. Proximal limb amputations with larger muscle
mass were at higher risk of developing reperfusion syndrome and such events had higher
chances of limb loss. Major limb amputations within 2 hours of warm ischemia time
even with prolonged cold ischemia can be successfully replanted with closed perioperative
monitoring.
Keywords
major replantation - reperfusion syndrome - prolonged ischemia
