Abstract and Introduction
Tremendous advances have been made in the field of digital replantation since its introduction a half century ago. The purpose of this article is to provide an overview about established techniques and new trends in the field of replantation and revascularization of amputated hands and digits. Controversial issues are discussed. Emphasis is placed on indications for replantation and revascularization.
Traumatic amputation of the digits or hand are devastating injuries, causing tremendous psychosocial and functional consequences. Replantation and revascularization of severed extremity parts have been practiced since 1962, when Malt and McKhann successfully replanted the amputated arm of a teenage child. The first successful replantation of a thumb was performed Komatsu and Tamai in 1965. Since, replantation has become an accepted treatment modality and has become the standard of care.
Because of refinements of surgical technique, the limits of microanastomosis have been pushed further, rendering replantation of digital tip amputations technically feasible, even in children.
In the beginning of replantation surgery, the injured digits often were stiff, insensate, and painful. A more critical approach to the indications for replantation with consideration of long-term functionality led surgeons to abandon replantation in patients with poor functional expectations. Today, living parts without sensation or function often are considered unacceptable.
Curr Orthop Pract. 2012;23(4):284-288. © 2012 Lippincott Williams & Wilkins