gms | German Medical Science

Objectives/Interrogation: 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. 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 creativity of the surgeon. This is true in the emergency setting, and for patients undergoing secondary reconstructive surgery.

Methods: Over the past 10 years we have collected 17 cases of consecutive cases of "borderline indications" that in the past would not have been considered for replantation: double level replantations, avulsion injuries, patients over 75 years of age, significant degloving injuries, longer than suggested revascularization time, etc.The minimum follow-up was 1 year and each case has been analyzed using Chen's criteria for assessment of residual function. All secondary procedures are pointed out. Failures are also reported.

Results and Conclusions: In all the cases presented, the replanted segment survived. There were no major complications in the survived segment. Reoperation was necessary in 20% of cases (tendon transfer, tenolysis, etc.). All patients said they were satisfied with the treatment.

This case series suggests how to deal with special cases and will 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 as long as the patient's life is not in danger.