Upper Extremity Replantation – A Review

BACKGROUND: In the early 1970s, replantation surgery became an important addition to the armamentarium of reconstructive surgery. In view of the heavy institutional commitment, it became quickly obvious that this type of advanced surgery cannot be performed in all places as occasional surgery. METHODS: This article provides a review of the evolution of upper extremity replantation over the past 20 years with regard to indications, basic surgical techniques, and final results. RESULTS: Thirty-eight major upper extremity replantations have recently been analysed and compared with 182 replantations performed 20 years ago, using the same data and the same format in both series. No significant differences could be found between these two groups. Analysing this 20-year period, one finds that few changes took place. The only major change that could be ascertained was a significant decrease in the number of replantations in Switzerland due to improved safety measures for working with dangerous machines. Most probably this is true in general for all highly industrialized countries. CONCLUSIONS: Replantation of the upper extremity is a well established method in the treatment of amputation injuries that has a substantial socioeconomic impact. These replantation procedures are very demanding: special skills and experience of the surgical team is the basis for excellent long-term functional results.