Replantation in the mutilated hand.
With the evolution of surgical techniques and scientific technology, replantation has become more refined, establishing specific indications for replantation, rituals for preparation, efficient techniques to ultimately minimize ischemia times, improved survival rates, guidelines for postoperative care, strategies for treating complications, and goals for outcomes. Patient satisfaction hinges on their level of expectation as defined and explained in the preoperative discussion and informed consent. Studies have demonstrated patients can be expected to achieve 50% function and 50% sensation of the replanted part. Initially all that was amputated was replanted, as surgeons adopted the philosophy of George C. Ross (1843-1892): "Any fool can cut off an arm or leg but it takes a surgeon to save one." Forty years after the first replant (1962-2002), however, we recognize the ultimate goal: not merely to preserve all living tissue through nonselective replantation, but rather to preserve one's quality of life by improving their function and appearance. This objective to care for the patient with the intent to optimize function and appearance is important not only to the replantation of amputations but to all mutilated hand injuries.
Wilhelmi
Bradon J
BJ
Hand/Microsurgery, The Plastic Surgery Institute at Southern Illinois University School of Medicine, 747 North Rutledge, 3rd Floor, Springfield, Illinois 62794, USA. bwilhelmi@Siumed.edu
Lee
W P Andrew
WP
Pagenstert
Geert I
GI
Pagensteert
Geert I
GI
May
James W
JW
D000673:Amputation, Traumatic / Q000601:surgery*; D003646:Debridement; D005383:Finger Injuries / Q000601:surgery; D005593:Fracture Fixation, Internal; D050723:Fractures, Bone / Q000601:surgery; D006225:Hand / Q000098:blood supply / Q000294:innervation; D006230:Hand Injuries / Q000601:surgery*; D006801:Humans; D023821:Limb Salvage; D011182:Postoperative Care; D017534:Radial Artery / Q000601:surgery; D019651:Plastic Surgery Procedures; D012092:Replantation / Q000379:methods; D013710:Tendons / Q000601:surgery