Review article

An overview of replantation and transplantation of the upper extremity

Ivan Kirin ; Klinika za kirurgiju, KBC Rijeka, Rijeka, Hrvatska
Koraljka Juretić Franković ; Klinika za kirurgiju, KBC Rijeka, Rijeka, Hrvatska
Miljenko Kovačević ; Klinika za kirurgiju, KBC Rijeka, Rijeka, Hrvatska
Grgo Martinović ; Klinika za kirurgiju, KBC Rijeka, Rijeka, Hrvatska
Davor Primc ; Klinika za kirurgiju, KBC Rijeka, Rijeka, Hrvatska

Abstract

The main goal of replantation is the re-establishment of extremity perfusion and minimization of ischemia time. Operational microscope and microvascular surgical technique are the basis of replantation and revascularization. The following operations are used in replantation: osteosynthesis, anastomosis and reconstruction of vascular elements, reconstruction of nerves, tendons or muscles and cover. Contraindications for replantation are classified as absolute and relative ones. Absolute contraindications include amputation with polytrauma, extensive injury and chronic diseases. Relative contraindications are one finger amputation, patient older than 50 years, avulsions, long warm ischemia (more than 12 hours for fingers and 6-8 hours for upper arm and forearm), severe contamination and earlier injury with poor functional result. Favored replantations include children, thumb and more hand fingers. Transplantation of vascularized extremity or its parts is defined as allotransplantation of composite tissue, offering new therapeutic opportunities for patients with an amputated arm. The common postoperative care consists of elevation of replanted extremity, anticoagulation therapy, monitoring of color, skin turgor, capillary filling and temperature, administration of antibiotics, prohibition of smoking, coffee and chocolate, in order to prevent peripheral vasospasm and eventual risk of vascular thrombosis. The first successful thumb replantation in Clinical Hospital Center Rijeka was performed in 1980, and forearm replantation in 1983. Although replantation can be extremely expensive, requiring extended hospitalization and postoperative therapy, total expenses could be considerably lower than myoelectrical prosthesis which must be changed periodically. Nevertheless, an experienced team of doctors and highly motivated patients contribute to operation success, as well as satisfaction with both cosmetic and functional result.

Keywords

amputation; arm; replantation; transplantation

Hrčak ID:

80226

URI

https://hrcak.srce.hr/80226

Publication date:

1.3.2012.

Article data in other languages: croatian

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