title: Secondary reconstructive surgery following major upper extremity replantation.
abstract: BACKGROUND
  Little literature currently exists on reconstructive strategies following successful upper extremity replantation. The authors hypothesized that the type of secondary surgery would vary predictably depending on mechanism and amputation level.
  
  
  METHODS
  The authors performed a retrospective review of upper extremity replantations performed at their institution between 2003 and 2012. The mean follow-up period was 3 years. Patient, injury, and surgical demographics, as well as replantation survival rates and secondary surgical procedures, were recorded.
  
  
  RESULTS
  Forty-five upper extremity replantations met inclusion criteria and the survival rate was 89 percent (n = 40). In 40 cases of successful replantation, the average number of secondary surgical procedures was three per patient (range, zero to seven). The most common reconstructive procedures were soft-tissue coverage (n = 24), tenolysis (n = 24), free functioning muscle transfer (n = 18), and tendon transfer (n = 14). For upper arm replantations, soft-tissue coverage was the most common secondary surgery; free functioning muscle transfer was the most common for amputations between the elbow and mid-forearm; tenolysis was the most common secondary procedure performed for amputations of the distal forearm to wrist.
  
  
  CONCLUSIONS
  Proximal-level amputations commonly required soft-tissue coverage. Amputations through the proximal forearm and elbow often underwent free functioning muscle transfer, and tenolysis was the most common secondary surgery following distal forearm and wrist amputations. Secondary surgery could be predicted based on the anatomic levels of injury.
authors.affiliation: New York, N.Y.; and Linkou, Taiwan From the Hospital for Special Surgery and Chang Gung Memorial Hospital, Chang Gung Medical College.
authors.forename: Duretti
authors.initials: D
authors.lastname: Fufa
authors.forename: Cheng Hung
authors.initials: CH
authors.lastname: Lin
authors.forename: Yu Te
authors.initials: YT
authors.lastname: Lin
authors.forename: Chung Chen
authors.initials: CC
authors.lastname: Hsu
authors.forename: Chwei Chin
authors.initials: CC
authors.lastname: Chuang
authors.forename: Chih Hung
authors.initials: CH
authors.lastname: Lin
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000673:Amputation, Traumatic / Q000601:surgery*; D001134:Arm Injuries / Q000601:surgery*; D002648:Child; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019651:Plastic Surgery Procedures / Q000379:methods*; D012092:Replantation; D012189:Retrospective Studies; D055815:Young Adult