Since the first successful arm replantation reported by Malt and McKhann in 1962, developments and refinements to upper extremity replantation techniques have led to higher success rates with better functional outcomes. One of the most important determinants of a successful macroreplantation is the ischaemic time of the amputated part, as irreversible muscle necrosis begins after 6 hours of warm ischaemia. With major trauma and plastic surgery units usually covering a wide geographical area, it is often difficult to ensure patient injury to revascularization time is less than 6 hours. In 1981, Nunley et al described the temporary catheter perfusion technique in upper limb replantation surgery to reduce ischaemia time without any significant complications. When used in appropriate cases this technique can reduce complication rates in upper limb replantation surgeries.
Material and methods
Temporary catheter first perfusion was used in a hand replantation after 6 hours of warm ischaemia, with preservation of the intrinsic muscles, as evidenced by return of function. The technique used is described, along with relevant literature.
Temporary catheter perfusion allowed early reperfusion of the amputated hand, improving the chance of intrinsic muscle preservation despite delayed presentation. It allowed better wound evaluation and debridement, and facilitated better bone stabilisation prior to vascular repair.
Temporary catheter perfusion is well described in proximal upper limb replantation procedures. This case shows that it is also a useful adjunct for hand replantation, particularly when the patient presents with a critical duration of warm ischaemia.
To read this article in full you will need to make a payment
Purchase one-time access:Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
One-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:Subscribe to Journal of Plastic, Reconstructive & Aesthetic Surgery
Already a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
- Replantation outcomes.Clin Plast Surg. 2007; 34: 177-185
- Replantation of severed arms.JAMA. 1964; 10: 716-722
- Replantation in the mutilated hand.Hand Clinics. 2003; 19: 89-120
- Cross-limb vascular shunting for major limb replantation.Hand Surg Microsurg. 2009; 62: 139-143
- Temporary catheter perfusion and artery-last sequence of repair in macroreplantations.J Plast Reconstr Aesthet Surg. 2009; 62: 1321-1325
- Arterial shunting as an adjunct to major limb revascularization.Ann Surg. 1981; 193: 271-273
- Wrist level and proximal-upper extremity replantation.Hand Clin. 2007; 23: 13-21
- Invited commentary on ‘Temporary catheter perfusion and artery-last sequence of repair in macroreplantations’.J Plast Reconstr Aesthet Surg. 2009; 62: 1326
Published online: September 28, 2011
Accepted: September 5, 2011
Received in revised form: July 8, 2011
Received: May 9, 2011
© 2011 Published by Elsevier Inc.