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and must be performed within several hours of the part's amputation, at a center with specialized equipment, surgeons and supporting staff. To improve the chances of a successful replantation, it is necessary to preserve the amputated part as soon as possible in a cool (close to freezing, but not at
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time tolerated. Parts that contain major muscle groups, such as the arms, need to be replanted within 6–8 hours to have a viable limb. It is also important to collect and to preserve those amputates which do not appear to be good candidates for replantation. A microsurgeon needs all available parts
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Following replantation, patients should recover in an intensive care unit for 24 to 48 hours due to the need for frequent clinical assessments to monitor for signs of replantation failure. The most common and practical clinical assessment method is to monitor the temperature of the replanted part,
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and placed inside a clean or sterile bag floating in ice water. Dry ice should not be used as it can result in freezing of the tissue. There are so-called sterile "Amputate-Bags" available which help to perform a dry, cool, and sterile preservation.
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to reattach damaged areas of skin. After this procedure successfully restored blood flow to the severed arm, the nerves of the arm were repaired in
September 1962, with full arm function being achieved within four years of the incident.
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In replantation surgery following macro-amputation (e.g. arm or leg amputation), maximal length of the replanted extremity can be preserved by vascular grafts for blood supply and pedicled or free soft tissue flaps for defect coverage.
255:'s hand was reattached at the level of the distal forearm. In this case, vascular couplers were used for the vessels as the Chinese did not have good microsutures at that time. As there was little communication between China and the
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of human tissue to cover the wound at the stump and prevent further shortening. In cases of multiple amputation, nerves and vessels from a non-replantable part can be used as graft material for a replanted part.
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Replantation of amputated parts has been performed on fingers, hands, forearms, arms, toes, feet, legs, ears, scalp, face, lips, penis and a tongue. It can be performed on almost any body part of children.
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524:, Roffeis J, Disch AC, Schaser KD, Schwabe P. Complete major amputation of the upper extremity: Early results and initial treatment algorithm. J Trauma Acute Care Surg. 2015 Mar;78(3):586-93.
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is defined as the surgical reattachment of a body part (such as a finger, hand, or toe) that has been completely cut from the body. Examples include reattachment of a partially or fully
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The first revascularization of a partially amputated finger was performed by
Kleinert in 1963. The first digital replantation was performed in 1965 by Komatsu and Tamai in Japan.
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when he fell and was thrown against a stone wall, severing his right arm cleanly at the shoulder. During the procedure, doctors reconnected blood vessels, including the right
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The first report of a replantation using "modest magnification and keen vision" was reported in 1963 by a team led by Chen Zhong-wei of the Sixth People's
Hospital in
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to the point of precluding rejoining of essential blood vessels, making replantation impossible. In such cases, revision amputation of the stump may be necessary.
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The repair of the nerves and vessels (artery and vein) of the amputated part is essential for survival and function of the replanted part of the body. Using an
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as a surgical specialty in Soviet medicine. Soon after that, new specialised microsurgical centers were founded in different regions of the Soviet Union.
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101:. Sharp, guillotine-type injuries with relatively uninjured surrounding tissue have the best post-replantation prognosis, with a success rate of 77%.
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Parts without major muscle groups, such as the fingers, have been replanted up to 94 hours later, although 12 hours is typically the maximum
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should be used every hour to assess arterial blood flow to the replanted part. Maintaining adequate IV hydration helps ensure
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replantation. However, vessels and nerves of large amputated parts (e.g. arm and forearm) may be reconnected using
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338:. Skinner, Harry B., McMahon, Patrick J. (Physician) (5th ed.). New York: McGraw-Hill Medical. 2014.
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Win, Thet Su; Henderson, James (2014-02-10). "Management of traumatic amputations of the upper limb".
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in 1964 their first two replantations without referencing the earlier published article from China.
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or below freezing) and sterile (or clean) environment. Parts should be wrapped with moistened
427:. Stone, C. Keith., Humphries, Roger L. (7th ed.). New York: McGraw-Hill Medical. 2011.
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The world's first replantation was performed in May 1962 by a team of chief residents led by
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which should be at least 31 °C (88 °F). Other physical examination signs include
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A replanted finger tip, reattached to its respective finger through the use of
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can be used to remove blood from the replanted part if there are signs of
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in those years, Ronald Malt and
Charles McKhann published in
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should be taken daily for up to 3 weeks after replantation.
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To reduce the risk of blood clots at the site of the
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Current diagnosis & treatment emergency medicine
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536:"May 23, 1962: Give That Kid a Hand!"
388:Janis, Jeffrey E., ed. (2014-03-05).
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215:Massachusetts General Hospital
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390:Essentials of Plastic Surgery
77:finger, or reattachment of a
108:, multi-level injuries, and
472:BMJ (Clinical Research Ed.)
149:for replantation is termed
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606:Tests and procedures on
187:blood vessel anastomosis
571:eMedicine: Replantation
248:Chinese Medical Journal
182:of the replanted part.
455:: CS1 maint: others (
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124:Replantation requires
157:or no magnification.
147:operating microscope
99:traumatic amputation
83:avulsion-type injury
227:hop a freight train
277:Nicolai L. Volodos
176:Doppler ultrasound
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199:venous congestion
110:avulsion injuries
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612:soft tissue
520:Märdian S,
235:skin grafts
211:Ronald Malt
174:and color.
114:soft tissue
763:Amputation
752:Categories
720:Amputation
704:Bursectomy
686:Fasciotomy
553:2023-08-06
522:Krapohl BD
308:References
297:Amputation
548:1059-1028
492:1756-1833
451:cite book
443:711520941
362:cite book
354:820106991
253:machinist
180:perfusion
120:Technique
75:amputated
663:Tenotomy
508:38575564
500:24516069
478:: g255.
291:See also
243:Shanghai
165:Recovery
139:ischemic
628:Myotomy
281:Kharkiv
271:In the
205:History
191:aspirin
104:Severe
678:Fascia
655:Tendon
620:Muscle
608:muscle
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219:Boston
155:loupes
79:kidney
713:Other
696:Bursa
540:Wired
504:S2CID
131:gauze
55:[
610:and
544:ISSN
496:PMID
488:ISSN
457:link
439:OCLC
429:ISBN
402:ISBN
368:link
350:OCLC
340:ISBN
262:JAMA
251:. A
480:doi
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217:in
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Text is available under the Creative Commons Attribution-ShareAlike License. Additional terms may apply.
