Upper extremity replantation

Abstract

Over the last 20 years, advances in replantation surgery have been remarkable in demonstrating the ability of well-trained surgeons to return viability to amputated parts. Similarly remarkable is the potential for difference between viability and functional ability. The most important determinants are proper patient selection and the recognition of vascular compromise. Undoubtedly, the major contribution in the next 20 years of replantation and microsurgery will be a monitoring device that directs attention to the sight of the problem, whether it be venous, arterial, or both. The contribution of altering coagulation can certainly be questioned. Ideally, a well-performed anastomosis in a well-prepared bed should need no 'pharmacological assistance'. However, the ideal is often the exception. In these procedures, an empirical approach to anticoagulation has been presented. Finally, there is no controversy regarding the contribution of physical therapy, without which the management of these patients would be as frustrating as the performance of replantation without the operative microscope.