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Replantation and revascularization of the upper extremity: clinical experience of a microsurgical department in Portugal

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Abstract

Background

Since the pioneering works of Malt and Komatsu and Tamai in the 1960s, thousands of replantations and revascularizations of the upper extremity have been performed worldwide. The advent of microsurgery allowed surgeons to replant or revascularize essentially any amputated part. However, the mechanism of injury or patient comorbidities are important factors that can affect the outcomes.

Methods

Patients submitted to upper extremity replantation or revascularization between 2014 and June 2018 were retrospectively analyzed. Demographic features, type of accident, mechanism of injury, amputation level, and success rate were examined.

Results

Over the 4.5-year period, 45 replantations and 20 revascularizations were performed. The vast majority of patients were male. The mean age was 45.7 years old in the replantation group and 49.2 years old in the revascularization group. In both groups, the crush/avulsion injury was the most common mechanism. The overall success rate was 57.8% in replantation and 75% in revascularization. The failure in the replantation group was mainly due to arterial insufficiency.

Conclusions

The success of revascularization is higher than replantation; however, the mechanism of injury seems to be a critical determinant of the outcome.

Level of Evidence: Level IV, therapeutic study.

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Authors and Affiliations

  1. Department of Plastic, Reconstructive, Craniomaxilofacial Surgery and Microsurgery Unit, Gaia Hospital Center and Aveiro University, Rua Conceição Fernandes, s/n, 4434-502, Vila Nova de Gaia, Portugal

    Tiago Guedes, Marta Azevedo, João Morais, Carolina Andresen, Gustavo Coelho, Horácio Zenha & Horácio Costa

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  1. Tiago Guedes
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  2. Marta Azevedo
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  3. João Morais
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  4. Carolina Andresen
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  5. Gustavo Coelho
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  6. Horácio Zenha
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  7. Horácio Costa
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Correspondence to Tiago Guedes.

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Conflict of interest

Tiago Guedes, Marta Azevedo, João Morais, Carolina Andresen, Gustavo Coelho, Horácio Zenha, and Horácio Costa declare that they have no conflict of interest.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. For this kind of retrospective study, formal consent is not required.

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Guedes, T., Azevedo, M., Morais, J. et al. Replantation and revascularization of the upper extremity: clinical experience of a microsurgical department in Portugal. Eur J Plast Surg 42, 457–462 (2019). https://doi.org/10.1007/s00238-019-01520-2

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  • DOI: https://doi.org/10.1007/s00238-019-01520-2

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