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Major Amputations at the Arm and Forearm Level: Replantation Strategy and Technique

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Clinical Scenarios in Reconstructive Microsurgery

Abstract

Amputations at the arm and forearm level are an emergency frequently associated with potentially fatal concomitant injuries. The loss of a big segment of the upper limb is, however, a source of high disability for the patients, so every effort to replant the severed part should be made. First of all, the patients have to be evaluated by the anesthesiologist to understand the risk of replantation. Many different characteristics concerning the mechanism of trauma, ischemia time, and actual condition of the stump have to be considered before deciding whether to replant or not.

Once the indication is confirmed, the procedure has to be done as soon as possible. Reduce ischemia time by installing a temporary vascular shunt is one of the first measures to be undertaken. This provides the surgeon enough time for radical debridement and exposure of all soft, bony, and vascular structures at the level of the amputated segment and the stump.

Replantation is then performed from the bone to the soft tissues. Internal fixation is preferred to external fixation if possible. Tendon suture with six-strand technique is fundamental to enable a safe postoperative early mobilization of the replanted segment. Usually vascular and nerve grafts are required. If replantation is not indicated, consider other alternatives such as maintaining a long stump with fillet flap or, in very selected cases, performing ectopic replantation. Further surgical procedures are usually required and usually functional recovery will be modest; however, all patients will be more satisfied having got the chance to keep their own arm or forearm instead of having a prosthesis.

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Correspondence to Pierluigi Tos .

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Tos, P., Crosio, A., Giacalone, F., Battiston, B. (2022). Major Amputations at the Arm and Forearm Level: Replantation Strategy and Technique. In: Gravvanis, A., Kakagia, D.D., Ramakrishnan, V. (eds) Clinical Scenarios in Reconstructive Microsurgery. Springer, Cham. https://doi.org/10.1007/978-3-030-23706-6_54

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  • DOI: https://doi.org/10.1007/978-3-030-23706-6_54

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-23705-9

  • Online ISBN: 978-3-030-23706-6

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