Abstract

Forty years ago,Malt and McKhann in Boston and Chen, Chien, and Pao in Shanghai successfully replanted a severed arm for the first time. Nevertheless, the technique was regarded as sensational surgery of doubtful value to patients.

The western world became aware of successes in Chinese replantation after the 1973 report entitled “American replantation mission to China”. Owen's report from Australia contributed to the development of replantation surgery in a few centers in central Europe.

The objective of any replantation is restoration of the function of the severed member. In view of the innumerable uses to which a hand is put, replantation of an arm appears to be more important than that of a leg. A leg serves for locomotion, but an arm must perform diverse activities. The function of a leg amputated below or even above the knee can be adequately replaced by a modern prosthesis. In contrast, no single prosthesis can even approximately replace a functional hand.

Restoration of an adequate gripping function and of feeling are therefore the most important features of successful replantation. The most favorable conditions for the replantation of limbs are clean-cut injuries located as peripherally as possible. The higher the level of amputation, the larger the amputated part and the larger the muscular portion, the greater are the dangers of ischemia.

Patients and results. Between November 1975 and December 1999 we performed 72 arm replantations. A total of 58 of the reattached upper extremities healed without major complications. Functional results were graded according to Chen's classification (World J Surg 1978, 2: 513–524): grade I: the patient resumes original work, grade II: resumes some suitable work, grade III: carries on daily life, grade IV: (almost) no functional recovery.

Regained function was found in 38 out of 41 of our patients followed for 3–18 years. Indeed, 29 showed very good or good functional results (grade I or II).

The rate of healing was about 80%, the rate of functioning about 90%, and good to very good functional results were obtained in about 70% of patients. Work in the profession for which they had been trained or similar occupations was taken up by 60% of the patients.

Conclusion. Replantation of the upper limb has definitely passed beyond the stage of experimental exploration.The technical problems, in general,have been solved. In the hands of experienced surgeons functioning as a team,adequate upper extremity function can today be obtained. A rate of healing of nearly 80% was achieved, and a good functional result obtained in 60% of the patients. We conclude that the risks attributed to replantation surgery are avoidable. Since functional results were far better than anticipated at the beginning of the project, replantation should be considered the appropriate treatment for traumatic arm amputations.