Skip to main content
SpringerLink
Log in

Major limb, hand, and digital replantation

  • Published:
World Journal of Surgery Aims and scope Submit manuscript

Abstract

Successful replantation of an amputated extremity depends mainly upon the accurate repair of blood vessels, but the final goal must be complete restoration of function. Before a decision to replant is made, the extent of tissue damage, the patient's age and general condition, sex, occupation, and the patient's wishes regarding replantation are evaluated. All tissues that influence survival of the replanted part and its ultimate function must be repaired primarily. An operating microscope should always be used for the vascular and nerve repairs, especially in digital replantation. Good postoperative management is the final key for successful replantation, and includes prevention of thrombosis and adequate rehabilitation. Systemic heparinization is used in digital replantation, but is not used in major limb replantation. Rehabilitation is begun on the first post-operative day, but several reconstructive operations may be necessary on the replanted part to achieve improved function.

Between May, 1959 and December, 1977, replantation operations were performed in 218 extremities of 159 patients. Thirteen of 16 major limb replantations and 181 of 204 digital replantations have survived, an overall success rate of 88%. Functional recovery has varied in each individual for several reasons, but most patients are satisfied with the function of their replanted part.

Résumé

Dans les réimplantations de membres ou segments de membres amputés, le succès dépend principalement de la revascularisation, mais le but final doit être la récupération fonctionnelle complète. Avant de décider d'une réimplantation, il faut prendre en considération l'étendue des lésions tissulaires, l'âge du malade, son sexe et son état général, ses occupations et ses souhaits concernant la réimplantation. Tous les tissus qui vont influencer la survie du segment amputé et sa fonction doivent être immédiatement réparés et suturés. Pour les anastomoses vasculaires et nerveuses, il faut toujours travailler sous microscope opératoire, en particulier pour les réimplantations de doigts. Une surveillance et un traitement post-opératoires adéquats sont essentiels: il faut, entre autre, prévenir les thromboses et assurer une excellente rééducation. L'héparinisation est utilisée pour les réimplantations de doigts, mais pas pour les ré implantations de membres. La rééducation doit commencer dès le premier jour postopératoire; mais plusieurs opérations reconstructives peuvent être nécessaires pour atteindre un résultat fonctionnel satisfaisant.

Entre Mai, 1959 et Décembre, 1977, nous avons réalisé 218 réimplantations chez 159 patients. Sur 16 réimplantations de membres, 13 ont réussi et sur 204 réimplantations de doigts, 181 sont restées viables, soit au total 88% de succès. Le degré de la récupération fonctionnelle a été variable d'un malade à l'autre, pour des raisons diverses, mais la majorité des opérés sont satisfaits des résultats.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Hoephner, E.: Ueber Gefaessnaht, Gefaesstransplantationen und Replantation von amputierten Extremitaeten. Arch. Klin. Chir.70:417, 1903

    Google Scholar 

  2. Carrel, A., Guthrie, C.C.: Complete amputation of the thigh with replantation. Am. J. Med. Sci.131:297, 1906

    Google Scholar 

  3. Lapchinsky, A.: Recent result of experimental transplantation of preserved limbs and kidneys and possible use of this technique in clinical practice. Ann. N.Y. Acad. Sci.64:539, 1960

    Google Scholar 

  4. Snyder, C.C., Knowles, R.P.: Extremity replantation. Plast. Reconstr. Surg.26:251, 1960

    Google Scholar 

  5. Onji, Y., Murai, Y., Tamai, S., Hashimoto, T., Yamaguchi, T., Akiyama, H., Tsujimoto, A.: Experimental surgery on resuscitation and reunion of amputated or nearly amputated leg. Plast. Reconstr. Surg.31:151, 1963

    Google Scholar 

  6. Jacobson, J.H., Suarez, E.L.: Microsurgery in anastomosis of small vessels. Surg. Forum11:243, 1960

    Google Scholar 

  7. Buncke, H.J., Jr., Schulz, W.P.: Total ear replantation in the rabbit utilizing microminiature vascular anastomosis. Br. J. Plast. Surg.19:15, 1966

    Google Scholar 

  8. Buncke, H.J., Jr., Schulz, W.P.: Experimental digital amputation and replantation. Plast. Reconstr. Surg.36:62, 1965

    Google Scholar 

  9. Malt, R.A., McKhann, C.F.: Replantation of severed arms. J.A.M.A.189:716, 1964

    Google Scholar 

  10. Kleinert, H.E., Kasdan, M.L.: Anastomosis of digital vessels. J. Ky. Med. Assoc.63:106, 1965

    Google Scholar 

  11. Komatsu, S., Tamai, S.: Successful replantation of a completely cut-off thumb. Plast. Reconstr. Surg.42:374, 1968

    Google Scholar 

  12. McNeil, I.F., Wilson, J.S.P.: The problems of limb replacement. Br. J. Surg.57:365, 1970

    Google Scholar 

  13. Engber, W.D., Hardin, C.A.: Replantation of extremities. Surg. Gynecol. Obstet.132:901, 1971

    Google Scholar 

  14. Balas, T.: Replantation of amputated extremities. Vasc. Surg.7:1, 1973

    Google Scholar 

  15. First Teaching Hospital of Chung Shan Medical College: Replantation of severed limbs. Chin. Med. J.6:70, 1973

    Google Scholar 

  16. Ikuta, Y., Watari, S., Kubo, T., Oyama, K., Hiramatsu, K., Nakasaki, T., Mouri, T., Yoshimura, O., Hiramatsu, H., Tsuge, K.: The reattachment of severed fingers. Hiroshima J. Med. Sci.22:131, 1973

    Google Scholar 

  17. Kleinert, H.E., Serafin, D., Kutz, J.E., Atasoy, E.: Replantation of amputated digits and hands. Orthop. Clin. North Am.4:957, 1973

    Google Scholar 

  18. Miller, G.D.H.: An assessment of the place of microvascular repair in traumatic amputations of the upper limbs. Aust. N.Z. J. Surg.43:19, 1973

    Google Scholar 

  19. Nasseri, M., Voss, H.: Late results of successful replantation of upper and lower extremities. Ann. Surg.177:121, 1973

    Google Scholar 

  20. O'Brien, B.M., MacLeod, A.M., Miller, G.D.H., Newing, R.K., Hayhurst, J.W., Morrison, W.A.: Clinical replantation of digits. Plast. Reconstr. Surg.52:490, 1973

    Google Scholar 

  21. Peking Chishueit'an Hospital: Replantation of severed limbs. Chin. Med. J.6:67, 1973

    Google Scholar 

  22. Shanghai Sixth People's Hospital: Some comments on functional recovery of limb (finger) replantation. Chin. Med. J.6:73, 1973

    Google Scholar 

  23. Tsai, T.-M.: Experimental and clinical application of microvascular surgery. Ann. Surg.181:169, 1975

    Google Scholar 

  24. Tamai, S., Hori, Y., Tatsumi, Y., Okuda, H., Mii, Y.: Little finger replantation in a 20-month-old child. Br. J. Plast. Surg.27:1, 1974

    Google Scholar 

  25. Tamai, S., Tatsumi, Y., Shimizu, T., Hori, Y., Okuda, H., Takita, T., Sakamoto, H., Fukui, A.: Traumatic amputation of digits: the fate of remaining blood. An experimental and clinical study. J. Hand Surg.2:13, 1977

    Google Scholar 

  26. Weiland, A.J., Villarreal-Rios, A., Kleinert, H.E., Kutz, J., Atasoy, E., Lister, G.: Replantation of digits and hands: analysis of surgical techniques and functional results in 71 patients with 86 replantations. J. Hand Surg.2:1, 1977

    Google Scholar 

  27. Lendvay, P.G.: Replacement of the amputated digit. Br. J. Plast. Surg.26:398, 1973

    Google Scholar 

  28. Ch'en, C.W., Ch'ien, Y.C., Pao, Y.S., Lin, C.T.: Further experience in the restoration of amputated limbs. Chin. Med. J.84:225, 1965

    Google Scholar 

  29. Kleinert, H.E., Juhala, C.A., Tsai, T.-M., Van Beek, A.: Digital replantation: selection, technique, and results. Orthop. Clin. North Am.8:309, 1977

    Google Scholar 

  30. Tamai, S., Hori, Y., Tatsumi, Y., Okuda, H., Nakamura, Y., Sakamoto, H., Takita, T., Fukui, A.: Microvascular anastomosis and its application on the replantation of amputated digits and hands. Clin. Orthop.133:106, 1978

    Google Scholar 

  31. Verdan, C.: Primary repair of flexor tendons. J. Bone Joint Surg. [Am.]42:647, 1960

    Google Scholar 

  32. Kleinert, H.E., Kutz, J.E., Atasoy, E., Stormo, A.: Primary repair of flexor tendons. Orthop. Clin. North Am.4:865, 1973

    Google Scholar 

  33. O'Brien, B.M., Miller, G.D.H.: Digital reattachment and revascularization. J. Bone Joint Surg. [Am.]55:714, 1973

    Google Scholar 

  34. Lendvay, P.G.: Replacement of amputated digits and extremities. In Symposium on Reconstructive Hand Surgery, Littler, J.W., Cramer, L.M., Smith, J.W., editors. Saint Louis, Mo., C.V. Mosby Co., 1974, p. 300

    Google Scholar 

  35. Biemer, E., Duspiva, W., Herndl, H., Stock, W., Ramatschi, P.: Results of 150 replantations on the upper extremity with microvascular surgery. Read at the 3rd Congress of the European Section of the International Confederation of Plastic and Reconstructive Surgery, The Haag, The Netherlands, May 22–27, 1977

  36. O'Brien, B.M.: Replantation surgery. Clin. Plast. Surg.1:405, 1974

    Google Scholar 

  37. Eiken, O., Nabseth, D.C., Mayer, R.F., Deterling, R.A., Jr.: Limb replantation. II. The pathophysiological effects. Arch. Surg.88:54, 1964

    Google Scholar 

  38. Mehl, R.L., Paul, H.A., Shorey, W., Schneewind, J., Beattie, E.J., Jr.: Treatment of toxemia after extremity replantation. Arch. Surg.89:871, 1964

    Google Scholar 

  39. Onji, Y., Kohama, A., Tamai, S., Fukunishi, H., Komatsu, S.: Metabolic alterations following replantation of an amputated extremity. Hiroshima J. Med. Sci.41:55, 1967

    Google Scholar 

  40. Usui, M. et al.: An experience of a completely amputated leg. Operation28:1349, 1974

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Orthopedic Surgery, Nara Medical University Hospital, Kashihara, 634, Nara, Japan

    Susumu Tamai M.D., Yoshihide Hori M.D., Yoshitaka Tatsumi M.D., Hisao Okuda M.D., Yoshiya Nakamura M.D., Hiroshi Sakamoto M.D. & Takehiko Takita M.D.

Authors
  1. Susumu Tamai M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Yoshihide Hori M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Yoshitaka Tatsumi M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Hisao Okuda M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Yoshiya Nakamura M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Hiroshi Sakamoto M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Takehiko Takita M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Tamai, S., Hori, Y., Tatsumi, Y. et al. Major limb, hand, and digital replantation. World J. Surg. 3, 17–28 (1979). https://doi.org/10.1007/BF01556384

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF01556384

Keywords

Search

Navigation