Upper extremity replantation: current concepts.
BACKGROUND
Upper extremity replantation is a procedure that has revolutionized hand surgery. Since its introduction, a rapid evolution has occurred with a shifting focus from implant survival to optimization of functional outcomes and surgical efficiency. In this review, the current concepts surrounding the indications for replantation, variations in surgical technique, the factors affecting outcomes, and future directions of the specialty are analyzed.


METHODS
A literature review was performed of all recent articles pertaining to digit, hand, and upper extremity replantation surgery. Particular emphasis was placed on comparative studies and recent meta-analyses.


RESULTS
The indications and contraindications for replantation surgery are largely unchanged, with mechanism of injury remaining one of the most important determinants of implant survival. With advances in surgical technique, improved outcomes have been observed with avulsion injuries. Distal tip replantations appear to be more common with improved microsurgical techniques, and for these distal injuries, digital nerve and vein repair may not be necessary. Cold ischemia time for a digit amputation should not preclude transfer to a replantation facility or significantly affect the decision to perform a replantation. However, transferring physicians should thoroughly review the options with patients to prevent unnecessary transfers, which is an area where telemedicine may be useful.


CONCLUSIONS
This review provides an update on the current concepts of the practice of replantation and the treatment and management of patients with upper extremity amputations.
Seattle, Wash. From the Division of Plastic Surgery, University of Washington.
Roni B
RB
Prucz
Jeffrey B
JB
Friedrich
D000673:Amputation, Traumatic / Q000601:surgery*; D006801:Humans; D012092:Replantation / Q000379:methods; D034941:Upper Extremity / Q000293:injuries* / Q000601:surgery*