Limb replantation after avulsion injuries: techniques and tactics for success.
OBJECTIVE
Retrospective evaluation of cases of limb replantation after avulsion injuries. Evaluation of the techniques and tactics used, that contributed to success and good functional results.


METHODS
Forty-three patients' records were assessed. All the cases had been submitted to limb replantation after avulsion injuries.


RESULTS
The majority of the cases were young men. The most common injury was to the thumbs. The surgical techniques and tactics used were: nerve grafting, vein grafting, transposition of the digital vessels, limb shortening, and heterotopic replantation. The most commonly used technique was vein graft. The limb survival rate was high (93%), as was patient satisfaction.


CONCLUSIONS
Replantation after avulsion injury depends on the correct diagnosis of the limb viability and the use of appropriate surgical techniques and tactics for each case. The experience of the team of surgeons and a good hospital structure are essential for good results. There are few articles in medical literature about the indications, techniques and results of limb replantation after avulsion injuries. We believe that this retrospective evaluation can bring new information and contributions to the correct management of this highly complex situation. Level of evidence IV, Case Series.
Hand Group of the Institute of Orthopedics and Traumatology of Hospital das Clínicas of the School of Medicine of Universidade de São Paulo - São Paulo, SP, Brazil.
Renata Gregorio
RG
Paulos
Hand Group of the Institute of Orthopedics and Traumatology of Hospital das Clínicas of the School of Medicine of Universidade de São Paulo - São Paulo, SP, Brazil.
Danielle Tiemi
DT
Simão
Hand Group of the Institute of Orthopedics and Traumatology of Hospital das Clínicas of the School of Medicine of Universidade de São Paulo - São Paulo, SP, Brazil.
Rames
R
Mattar Júnior
Hand Group of the Institute of Orthopedics and Traumatology of Hospital das Clínicas of the School of Medicine of Universidade de São Paulo - São Paulo, SP, Brazil.
Marcelo Rosa de Rezende Teng Hsiang
MR
Wei
Hand Group of the Institute of Orthopedics and Traumatology of Hospital das Clínicas of the School of Medicine of Universidade de São Paulo - São Paulo, SP, Brazil.
Luciano Ruiz
LR
Torres
Evaluation of the results of therapeutic interventions; Replantation; Traumatic amputation