Replantation-Overview - Replantation

Overview - Replantation
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Replantation is the surgical procedure of reattaching a completely amputated part, such as a limb or digit, to its original site in the body. The viability rates for replantation approach 90%, although the function of the replanted part may not be fully restored. Replantation is considered when it is expected to improve function postoperatively compared to revision amputation and the use of a prosthesis. Major limb amputations involve skeletal muscle, while minor limb amputations involve limited skeletal muscle. Replantation is performed within an acceptable ischemia time, which depends on the level of injury and the amount of muscle involved. Thumb replantation is important because of the digit's functional significance. Multiple digit loss results in significant functional compromise, and the least-damaged digits should be replanted in the most functional positions. Zone I injuries distal to the flexor digitorum superficialis (FDS) insertion are technically easier and result in improved sensation and appearance. Replantation is possible for almost any part of a child's body, with a better chance of functional recovery compared to adults. Sharp guillotine type injuries have the best prognosis for replantation. Contraindications include crush or avulsion injuries, replantation of border digits, amputation at multiple levels, contamination, comorbidities, elderly patients with arteriosclerotic vessels, and life-threatening injuries. Preoperative assessment includes cooling the amputated part, determining historical factors, conducting a physical exam, and performing imaging studies. Surgical technique involves debridement, bone shortening and fixation, tendon repair, arterial and venous repair, nerve repair, and skin coverage. Results of replantation vary depending on the type and level of injury. Complications may include arterial or venous insufficiency, infection, stiffness, nonunion, and abnormal sensation.
Keywords
Replantation
surgical procedure
amputation
viability rates
limb
digit
function restoration
revision amputation
prosthesis
major limb amputations