J South Orthop Assoc. 2001;10(2) 

In This Article

Introduction

Since the first major limb replantation of an arm by Malt[1] in Boston in 1962 and the historic report of replantation of the thumb by Komatsu and Tamai[2] in 1968, revascularization and replantation of human digits has become a common occurrence. Over the past 40 years, the indications have been better delineated, with consequent improvement in outcome. Simultaneously, improved safety procedures in the workplace have diminished the incidence of work-related traumatic amputation. However, amputations continue to occur from a variety of mechanisms.

Replantation is defined as the reattachment of a completely amputated part. Revision of an amputation means closing the wounds in such a way as to optimize function and appearance after amputation when replantation cannot be done. In contradistinction to replantation, revascularization refers to the restoration of arterial and/or venous blood flow in an extremity or part that has sustained a crucial injury. If any portion of the distal part is connected to the body by normal anatomic structures, then this should not be considered a replantation.

The purpose of this article is to provide an overview of the current state of the art of replantation of digits, to outline the anatomic and physiologic considerations inherent in the procedure, and to delineate the indications for replantation in the 21st century. For more detailed information, Orthopaedic Care: Medical and Surgical Management of Musculoskeletal Disorders (www.orthotextbook.net) is available online from the Southern Orthopaedic Association, Clinical Orthopaedic Society, and affiliated organizations.

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