Replantation-Replantation Surgery

Replantation Surgery

Pdf Summary

The current concepts of replantation surgery can be discussed in terms of patients’ demands and expectations, present indications for the procedure, available evidence that influences decision making, and technical refinements practiced to produce better outcomes. When replantation surgery began, the surgeon guided the patient in decision making. Fifty years later, patients’ desire for replantation and the role of the surgeon in guiding the patient in the decision-making process remain unchanged. The skills of the surgical team, the infrastructure available, and the surgeon’s experience affect outcomes in replantation. The decision to replant is based on the determination that the anticipated function and overall well-being of the patient after replantation will be better than that after a revision amputation. The indication for digital replantation appears to be expanding. High success and patient satisfaction rates have been reported in fingertip replantation. Cost-benefit analyses of performing replantation versus shortening and closure of the amputation stump have been studied with varied results. Distal amputations to proximal forearm and wrist level amputations pose unique challenges to the surgeon. Temporary ectopic implantation is an option in exceptional circumstances. Outcome assessment in replantation is based on survival rate, sensory recovery, pain symptoms, cold intolerance, range of movement, and patient satisfaction. Technical considerations in replantation include access incision and debridement, bone shortening, tendon repairs, vessel repair, anticoagulation protocols, and monitoring of replantations. Secondary procedures such as tenolysis and nerve repair can enhance the functional outcome. The practice of replantation is shifting towards major centers with surgical expertise and infrastructure needed for quality care.

Keywords

replantation surgery

patient demands

indications

evidence

technical refinements

surgical team

amputation stump

digital replantation

outcome assessment

major centers