Macroreplantations of the upper extremity: a series of 11 patients

Leclère, Franck-Marie Patrick; Mathys, Lukas; Juon, Bettina; Franz, Torsten; Unglaub, Frank; Vögelin, Esther (2012). Macroreplantations of the upper extremity: a series of 11 patients. Archives of orthopaedic and trauma surgery, 132(12), pp. 1797-805. Springer-Verlag 10.1007/s00402-012-1590-8

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INTRODUCTION Micro- or macroreplantation is classified depending on the level of amputation, distal or proximal to the wrist. This study was performed to review our experience in macroreplantation of the upper extremity with special attention to technical considerations and outcomes. MATERIALS AND METHODS Between January 1990 and December 2010, 11 patients with a complete amputation of the upper extremity proximal to the wrist were referred for replantations to our department. The patients, one woman and ten men, had a mean age of 43.4 ± 18.2 years (range 19-76 years). There were two elbow, two proximal forearm, four mid-forearm, and three distal forearm amputations. The mechanism of injury was crush in four, crush-avulsion in five and guillotine amputation in two patients. The Chen classification was used to assess the postoperative outcomes. The mean follow-up after macroreplantation was 7.5 ± 6.3 years (range 2-21 years). RESULTS All but one were successfully replanted and regained limb function: Chen I in four cases (36 %), Chen II in three cases (27 %), Chen III in two cases (18 %), and Chen IV in one patient (9 %). We discuss the steps of the macroreplantation technique, the need to minimize ischemic time and the risk of ischemia reperfusion injuries. CONCLUSION Thanks to improvements in technique, the indications for limb preservation after amputation can be expanded. However, because of their rarity, replantations should be performed at specialist replantation centers. LEVEL OF EVIDENCE Level IV.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Orthopaedic, Plastic and Hand Surgery (DOPH) > Clinic of Plastic and Hand Surgery > Hand Surgery
04 Faculty of Medicine > Department of Orthopaedic, Plastic and Hand Surgery (DOPH) > Clinic of Plastic and Hand Surgery

UniBE Contributor:

Leclère, Franck-Marie Patrick; Mathys, Lukas; Juon, Bettina; Franz, Torsten and Vögelin, Esther

Subjects:

600 Technology > 610 Medicine & health

ISSN:

0936-8051

Publisher:

Springer-Verlag

Language:

English

Submitter:

Jörg Arnoldi

Date Deposited:

11 Mar 2014 14:41

Last Modified:

26 Jun 2018 14:24

Publisher DOI:

10.1007/s00402-012-1590-8

PubMed ID:

22886169

BORIS DOI:

10.7892/boris.42641

URI:

https://boris.unibe.ch/id/eprint/42641

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