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Research Article| Volume 60, ISSUE 7, P769-775, July 2007

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Salvage of replanted upper extremities with major soft-tissue complications

      Summary

      Soft-tissue complications in the replantation wound, either septic or non-septic, are the main cause of failure in major extremity replantations. In the presence of necrosis or infection, vascular errosion or thrombosis readily develops and can lead to limb loss. Very aggressive surgical treatment has been recommended to salvage the replanted limb in these highly unstable clinical situations. Over a 10-year period, 423 amputated parts were replanted, 56 of which were replants proximal to the wrist. The experience of the author in treating 11 cases of critical soft-tissue necrosis (four septic and seven non-septic) after major replantation of the upper extremity with aggressive debridement and flap coverage, is reported. All flaps and limbs survived.

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      References

        • Strauch B.
        • Greenstein B.
        • Goldstein R.
        • et al.
        Problems and complications encountered in replantation surgery.
        Hand Clin. 1986; 2: 389-399
        • Cavadas P.C.
        • Landin L.
        • Navarro-Monzonis A.
        • et al.
        Salvage of impending replant failure by temporary ectopic replantation: a case report.
        J Hand Surg [Am]. 2006; 31: 463-467
        • Shatford R.A.
        • King D.H.
        The treatment of major devascularizing injuries of the upper extremity.
        Hand Clin. 2001; 17: 371-393
        • Russell R.C.
        • O'Brien B.M.
        • Morrison W.A.
        • et al.
        the late functional result of upper limb revascularization and replantation.
        J Hand Surg [Am]. 1984; 9: 623-633
        • Wang S.H.
        • Young K.F.
        • Wei J.N.
        Replantation of severed limbs. Clinical analysis of 91 cases.
        J Hand Surg [Am]. 1981; 6: 311-318
        • Zhong-Wei C.
        • Meyer V.E.
        • Kleinert H.E.
        • et al.
        Present indications and contraindications for replantation as reflected by long-term functional results.
        Orthop Clin North Am. 1981; 12: 849-870
        • Chew W.Y.
        • Tsai T.M.
        Major upper limb replantation.
        Hand Clin. 2001; 17: 395-410
        • Nunley J.A.
        • Koman L.A.
        • Urbaniak J.R.
        Arterial shunting as an adjunct to major limb revascularization.
        Ann Surg. 1981; 193: 271-273
        • Chen S.H.
        • Wei F.C.
        • Chen H.C.
        • et al.
        Emergency free-flap transfer for reconstruction of acute complex extremity wounds.
        Plast Reconstr Surg. 1992; 89: 882-888
        • Lister G.
        • Scheker L.
        Emergency free flaps to the upper extremity.
        Am J Hand Surg. 1988; 13: 22-28
        • Brandt K.
        • Khouri R.K.
        • Upton J.
        free flaps as flow-though vascular conduits for simultaneous coverage and revascularization of the hand or digit.
        Plast Reconstr Surg. 1996; 98: 321-327
        • Datiashvili R.O.
        • Chichkin V.G.
        Flap transfer for complications of major limb replantation.
        Ann Plast Surg. 1993; 31: 327-330
        • Joseph T.N.
        • Chen A.L.
        • Di Cesare P.E.
        Use of antibiotic-impregnated cement in total joint arthroplasty.
        J Am Acad Orthop Surg. 2003; 11: 38-47
        • Schoifet S.D.
        • Morrey B.F.
        Treatment of infection after total knee arthroplasty by debridement with retention of the components.
        J Bone Joint Surg. 1990; 72A: 1383-1390
        • Yazar S.
        • Lin C.H.
        • Lin Y.T.
        • et al.
        Outcome comparison between free muscle and free fasciocutaneous flaps for reconstruction of distal third and ankle traumatic open tibial fractures.
        Plast Reconstr Surg. 2006; 117: 2468-2475
        • Cavadas P.C.
        • Sanz-Jimenez-Rico J.R.
        Use of the extended-pedicle vastus lateralis free flap for lower extremity reconstruction.
        Plast Reconstr Surg. 2005; 115: 1070-1076