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Digit and hand replantation

  • Trauma Surgery
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

For the past 45 years, the advent of microsurgery has led to replantation of almost every amputated part such as distal phalanx, finger tip, etc. Replantation of digits and hand can restore not only circulation, but also function and cosmetic of the amputated part. The goals of replantation are to restore circulation and regain sufficient function and sensation of the amputated part. Strict selection criteria are necessary to optimize the functional result. The management of this type of injuries includes meticulous preoperative management, microsurgical experience and continuous postoperative care. Among various factors influencing the outcome, the most important are the type and the level of injury, ischemia time, history of diabetes, age, sex, and smoking history. During the replantation procedure, bone stabilization, tendon repair, arterial anastomoses, venous anastomoses, nerve coaptation, and skin coverage should be performed. All structures should be repaired primarily, unless a large nerve gap or a flexor tendon avulsion injury is present. Adequate postoperative evaluation is mandatory to avoid early or late complications. To improve functional results, many replantation patients may need further reconstructive surgery.

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References

  1. Lee WP, Mathes DW (1999) Hand transplantation: pertinent data and future outlook. J Hand Surg 24A:906–913

    Google Scholar 

  2. Beris AE, Soucacos PN, Malizos KN, Mitsionis GJ, Soucacos PK (1994) Major limb replantation in children. Microsurgery 15:474–478

    Article  CAS  PubMed  Google Scholar 

  3. Kleinert HE, Kasdan ML, Romero JL (1963) Small blood vessel anastomosis for salvage of the severely injured upper extremity. J Bone Joint Surg Am 45:788–796

    PubMed  Google Scholar 

  4. Komatsu S, Tamai S (1968) Successful replantation of a completely cut-off thumb: case report. Plast Reconstr Surg 42:374–377

    Article  Google Scholar 

  5. Urbaniak JR, Evans JP, Bright DS (1981) Microvascular management of ring avulsion injuries. J Hand Surg 6A:25–30

    Google Scholar 

  6. Hanel DP, Chin SH (2007) Wrist level and proximal-upper extremity replantation. Hand Clin 23:13–21

    Article  PubMed  Google Scholar 

  7. Morrison WA, McCombe D (2007) Digital replantation. Hand Clin 23:1–12

    Article  PubMed  Google Scholar 

  8. Hierner R, Berger A, Brenner P (1998) Überlegungen zur Versorgung von subtotalen and totalen Makroamputationen an der oberen Extremität. Unfallchirurgie 101:184–192

    Article  CAS  Google Scholar 

  9. Soucacos PN (2001) Indications and selection for digital amputation and replantation. J Hand Surg 26B:572–581

    Google Scholar 

  10. Van Beek AL, Kutz JE, Zook EG (1978) Importance of the ribbon sign, indicating unsuitability of the vessel, in replanting a finger. Plast Reconstr Surg 61:32–35

    Article  PubMed  Google Scholar 

  11. Beris AE, Soucacos PN, Malizos KN, Xenakis TA (1994) Microsurgical treatment of ring avulsion injuries. Microsurgery 15:459–463

    Article  CAS  PubMed  Google Scholar 

  12. Kay S, Werntz J, Wolff TW (1989) Ring avulsion injuries: classification and prognosis. J Hand Surg 14A:204–213

    Google Scholar 

  13. Adani R, Marcoccio I, Castagnetti C, Tarallo L (2003) Long-term results of replantation for complete ring avulsion amputations. Ann Plast Surg 51:564–568 (discussion 569)

    Google Scholar 

  14. Dec W (2006) A meta-analysis of success rates for digit replantation. Tech Hand Upper Extr Surg 10:124–129

    Article  Google Scholar 

  15. Heistein JB, Cook PA (2003) Factors affecting composite graft survival in digital tip amputations. Ann Plast Surg 50:299–303

    Article  PubMed  Google Scholar 

  16. Janezic TF, Arnez ZM, Solinc M, Zaletel-Kragelj L (1996) One hundred sixty-seven thumb replantations and revascularisations: early microvascular results. Microsurgery 17:259–263

    Article  CAS  PubMed  Google Scholar 

  17. Waikakul S, Sakkarnkosol S, Vanadurongwan V, Un-nanuntana A (2000) Results of 1018 digital replantations in 552 patients. Injury 31:33–40

    Article  CAS  PubMed  Google Scholar 

  18. Sharma S, Lin S, Panozzo A, Tepper R, Friedman D (2005) Thumb replantation: a retrospective review of 103 cases. Ann Plast Surg 55:352–356

    Article  CAS  PubMed  Google Scholar 

  19. Soucacos PN, Beris AE, Malizos KN, Touliatos AS (1994) Bilateral thumb amputation. Microsurgery 15:454–458

    Article  CAS  PubMed  Google Scholar 

  20. Soucacos PN (1995) Microsurgery in orthopaedics. In: Casteleyn PP, Duparc J, Fulford P (eds) European instructional course lectures, vol 2. British Society of Bone and Joint Surgery, London, pp 149–156

  21. Lloyd MS, Teo TC, Pickford MA, Arnstein PM (2005) Preoperative management of the amputated limb. Emerg Med J 22:478–480

    Article  CAS  PubMed  Google Scholar 

  22. Holmberg J, Arner M (1994) Sixty-five thumb replantations: a retrospective analysis of factors influencing survival. Scand J Plast Reconstr Surg Hand Surg 28:45–48

    Article  CAS  PubMed  Google Scholar 

  23. Unglaub F, Demir E, Von Reim R, Van Schoonhoven J, Hahn P (2006) Long-term functional and subjective results of thumb replantation. Microsurgery 26:552–556

    Article  PubMed  Google Scholar 

  24. Beris AE, Soucacos PN, Malizos KN (1995) Microsurgery in children. Clin Orthop Relat Res 314:112–121

    PubMed  Google Scholar 

  25. Nunley JA, Spiegl PV, Goldner RD, Urbaniak JR (1987) Longitudinal epiphyseal growth after replantation and transplantation in children. J Hand Surg 12A:274–279

    Google Scholar 

  26. Touliatos AS, Soucacos PN, Beris AE, Zoubos AB, Koukoubis TH, Makris H (1995) Alternative techniques for restoration of bony segments in digital replantation. Acta Orthop Scand 66(Suppl 264):19–22

    Google Scholar 

  27. Sud V, Freeland AE (2002) Skeletal fixation in digital replantation. Microsurgery 22:165–171

    Article  PubMed  Google Scholar 

  28. Idler R, Steichen JB (1992) Complications of replantation surgery. Hand Clin 8:427–451

    CAS  PubMed  Google Scholar 

  29. Hovius SE, van Adrichem LN, Mulder HD, van Strik R, van der Meulen JC (1993) The predictive value of the laser Doppler flowmeter for postoperative microvascular monitoring. Ann Plast Surg 31:307–312

    Article  CAS  PubMed  Google Scholar 

  30. Hidalgo DA, Disa JJ, Cordeiro PG, Hu QY (1998) A review of 716 consecutive free flaps for oncologic surgical defects: refinement in donor-site selection and technique. Plast Reconstr Surg 102:722–732

    Article  CAS  PubMed  Google Scholar 

  31. Ichinose A, Tahara S, Terashi H, Nomura T, Omori M (2003) Short-term postoperative flow changes after free radial forearm flap transfer: possible cause of vascular occlusion. Ann Plast Surg 50:160–164

    Article  PubMed  Google Scholar 

  32. Cooley BC, Jones MM, Dellon AL (1983) Comparison of efficacy of thrombolysin streptokinase, and urokinase in a femoral vein clot model in rats. Microsurgery 4:1–4

    Article  CAS  PubMed  Google Scholar 

  33. Jacobs GR, Reinisch JF, Puckett CL (1981) Microvascular fibrinolysis after ischemia: its relation to vascular patency and tissue survival. Plast Reconstr Surg 68:737–741

    Article  CAS  PubMed  Google Scholar 

  34. Pederson WC (2001) Replantation. Plast Reconstr Surg 107:823–841

    Article  CAS  PubMed  Google Scholar 

  35. Conrad MH, Adams WP Jr (2001) Pharmacologic optimization of microsurgery in the new millennium. Plast Reconstr Surg 108:2088–2096

    Article  CAS  PubMed  Google Scholar 

  36. Olsson E, Svartling N, Asko-Seljavaara S, Lassila R (2001) Activation of coagulation and fibrinolysis in microsurgical reconstructions in the lower extremities. Br J Plast Surg 54:597–603

    Article  CAS  PubMed  Google Scholar 

  37. Askari M, Fisher C, Weniger FG, Bidic S, Lee WP (2006) Anticoagulation therapy in microsurgery: a review. J Hand Surg 31A:836–846

    Google Scholar 

  38. Kroll SS, Schusterman MA, Reece GP et al (1996) Timing of pedicle thrombosis and flap loss after free-tissue transfer. Plast Reconstr Surg 98:1230–1233

    Article  CAS  PubMed  Google Scholar 

  39. Klein-Weigel P, Pavelka M, Dabernig J, Rein P, Kronenberg F, Fraedrich G, Piza-Katzer H (2007) Macro- and microcirculatory assessment of cold sensitivity after traumatic finger amputation and microsurgical replantation. Arch Orthop Trauma Surg 127:355–360

    Article  PubMed  Google Scholar 

  40. Ojemann JG, Silbergeld DL (1995) Cortical stimulation mapping of phantom limb rolandic cortex: case report. J Neurosurg 82:641–644

    CAS  PubMed  Google Scholar 

  41. Pascual-Leone A, Peris M, Tormos JM, Pascual AP, Catalá MD (1996) Reorganization of human cortical motor output maps following traumatic forearm amputation. Neuroreport 7:2068–2070

    Article  CAS  PubMed  Google Scholar 

  42. Weiss T, Miltner WHR, Huonker R, Friedel R, Schmidt I, Taub E (2000) Rapid functional plasticity of the somatosensory cortex after finger amputation. Exp Brain Res 134:199–203

    Article  CAS  PubMed  Google Scholar 

  43. Brenneis C, Loscher WN, Egger KE et al (2005) Cortical motor activation patterns following hand transplantation and replantation. J Hand Surg 30B:530–533

    Google Scholar 

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, University of Ioannina, School of Medicine, 45110, Ioannina, Greece

    Alexandros E. Beris, Marios G. Lykissas, Anastasios V. Korompilias, Gregory I. Mitsionis, Marios D. Vekris & Ioannis P. Kostas-Agnantis

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  1. Alexandros E. Beris
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  2. Marios G. Lykissas
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  3. Anastasios V. Korompilias
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  4. Gregory I. Mitsionis
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  5. Marios D. Vekris
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  6. Ioannis P. Kostas-Agnantis
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Correspondence to Marios G. Lykissas.

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Beris, A.E., Lykissas, M.G., Korompilias, A.V. et al. Digit and hand replantation. Arch Orthop Trauma Surg 130, 1141–1147 (2010). https://doi.org/10.1007/s00402-009-1021-7

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  • DOI: https://doi.org/10.1007/s00402-009-1021-7

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