title: Challenges in replantation of complex amputations.
abstract: Surgical ingenuity has resulted in continuing microsurgical innovation in replantation. In this article, the authors define complex amputations as those that stretch the boundaries or fall outside traditionally defined indications for replantation. They discuss management of difficult situations involving multiple digit amputations, multiple-level amputations, prolonged ischemia, and multiple trauma. The role of transpositional and ectopic replantation, as well as the requirement for secondary procedures in replantation is also discussed. Although technically challenging, microsurgical management of complex amputations ultimately results in far superior outcomes.
authors.affiliation: Department of Plastic Surgery, Case Western Reserve University, Cleveland, Ohio.
authors.forename: Harvey
authors.initials: H
authors.lastname: Chim
authors.affiliation: Division of Plastic Surgery, Mayo Clinic, Rochester, Minnesota.
authors.forename: Marco A
authors.initials: MA
authors.lastname: Maricevich
authors.affiliation: Division of Plastic Surgery, Mayo Clinic, Rochester, Minnesota.
authors.forename: Brian T
authors.initials: BT
authors.lastname: Carlsen
authors.affiliation: Division of Plastic Surgery, Mayo Clinic, Rochester, Minnesota.
authors.forename: Steven L
authors.initials: SL
authors.lastname: Moran
authors.affiliation: Division of Plastic Surgery, University of Miami, Coral Gables, Florida.
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Salgado
authors.affiliation: Department of Plastic Surgery, Chang Gung Memorial Hospital, Taipei, Taiwan.
authors.forename: Fu-Chan
authors.initials: FC
authors.lastname: Wei
authors.affiliation: Division of Plastic Surgery, Mayo Clinic, Rochester, Minnesota.
authors.forename: Samir
authors.initials: S
authors.lastname: Mardini
keywords: amputation; ischemia; microsurgery; multiple digit replantation; multiple level amputation; multiple trauma; rehabilitation; replantation; transpositional replantation