Results of unusual indicatication in upper limb replantation
Pierluigi Tos, MD, PhD; Hand Surgery and Reconstructive Microsurgery Unit, Milan, Italy; Bruno Battiston, MD, PhD; UOC Hand Surgery, Turin, Italy
Over the years upper limb replantation of small and large segments has experienced a progressive widening of indications because of the improvements in reconstructive techniques both in emergency and in secondary surgery. While there are clear indications for replantation or amputation (general and local conditions of the patient and of the amputated segment, timing, etc.), there is on the other hand a "gray area" in which indications tend to depend on the "skill”, "experience" and inventiveness of the surgeon. This is true both in emergency and in the secondary reconstructive strategies.
MATERIALS AND METHODS
Over the past 10 years we have put together 17 cases of "borderline indications" that probably in the past would not have been considered for replantation: double level replantations, avulsion injuries, patients over 75 years of age, deglovements, longer than suggested revascularization time. The minimum follow-up is 1 year and each case has been analyzed using Chen's criteria of assessment of residual function. All secondary procedures are pointed out. Failures are also reported.
In all the cases presented, the replanted segment survived. There were no major complications in the survived segment. Reoperation was necessary only in 20% of cases (tendon transfer, tenolysis). All patients said they were satisfied with the treatment.
The case series that will be presented could give the audience suggestions on how to deal with special cases and could stimulate the use of imagination in this kind of surgery in extreme conditions. The goal of reconstruction should be restoration of function that is better than prosthetic replacement. It is clear that this type of surgery can only be performed so long as the patient's life is not in danger.
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