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At least 19 recordsLinked to original sources
PubMed1978

Replantation of untidily amputated finger, hand, and arm: experience of 99 replantations in 66 cases.

Three problems the authors think important in replantation of untidy amputations are discussed based on our 99 replantations with the success rate of 92.6% over a 4-year period. To restore circulation in this type of amputation, such techniques as transfer of blood vessels, use of a neurovascular island flap with neurovascular anastomoses at its distal margin, vein graft, and free split-skin graft directly on the anastomosed blood vessels are recommended. Recovery of tendon gliding when replanted proximally to the MP joint was reasonably good but not when replanted distally to it. Recovery of intrinsic muscles was generally poor. Protective sensation was usually regained, although occasionally accompanied by paresthesia. Amputation of single digit was found not to be an absolute indication for replantation except for the thumb. In multiple digital amputation, more important digits should be restored by amputated digits in better condition. Replantation for cosmetic improvement may be justified in such cases as unmarried young females. In infants, replantation is especially worthwhile because good functional recovery and good further growth can be expected.

Adolescent↗
PubMedDate not supplied

Late results in replanted digits. Is replantation of a single digit worthwhile?

During the period 1980-1989 35 patients with successfully replanted digits could be selected. Only 17 patients with 32 long fingers and 2 thumbs replanted were prepared to cooperate for this retrospective study, looking for the late functional results. Mobility of the replanted digits was measured by the TAM-value. Power was indicated by grip strength and tip pinch. Weber two-point discrimination test and Von Frey test were used to investigate sensibility. Most patients show cold-intolerance. Mobility was worse for the more proximal replantations. Replantations distal to PIP do functionally very well. Therefore single digit amputations should be considered as an indication for replantation, especially amputations distal to the pip. Ring and little finger replantations have a better mobility than index and middle fingers. Mobility in younger patients is also better. Grip strength and tip pinch are respectively 66% and 73% of the normal values. All patients (except 2) could return to their work in a reasonably short time (average 5 months).

Adolescent↗
PubMed1992

[The status of replantation centers and services in the area served by the German Professional Society of Microsurgery of Peripheral Nerves and Blood Vessels (Commission for Replantation)].

This survey concerns the years 1989 and 1990. While the number of institutions performing replantations remained constant in Austria and Switzerland, there has been a noticeable trend in Germany from around-the-clock replantation centers to simple replantation services, offering emergency microsurgery by arrangement only. The total number of replantations performed decreased from 975 replanted parts (903 microreplantations and 72 macroreplantations) in 1989 to 875 in 1990, with a micro-/macroreplantation ratio of 12.8:1. Based on the results of questionaire received from 34 university and city hospitals in Austria, Switzerland and former West Germany, an analysis of clinical organization and management of replantation services is presented.

Amputation, Traumatic↗
PubMed2006

Salvage of impending replant failure by temporary ectopic replantation: a case report.

Temporary ectopic replantation of amputated parts has been reported previously as an alternative to orthotopic replantation in difficult cases. We report a case in which the left arm initially was replanted orthotopically with subsequent development of extensive infection. The impending vascular failure of the replanted arm was salvaged by reamputation and temporary ectopic transfer of the arm to the groin region. Nine days later the arm was transferred back to the clean humeral stump. The functional result was similar to that of a standard transhumeral replantation, with 30 degrees to 120 degrees of active range of elbow motion, basic grip pattern, and S3 sensibility.

Adult↗
PubMed1980

Delayed replantation after submucosal storage in order to prevent root resorption after replantation. An experimental study in monkeys.

The purpose of this study was to determine the root resorption pattern of teeth autotransplanted to a submucosal site and to determine whether root resorption after replantation could be prevented by delayed replantation of teeth after submucosal storage in order to regenerate damaged periodontal ligament. Permanent teeth were extracted in green Vervet monkeys. One group of teeth was transplanted to a submucosal site and examined histologically in situ. Another group of teeth was autotransplanted to submucosal sites, recovered and replanted either 2 or 6 weeks later. The animals were sacrificed 8 week after replantation and examined histometrically. The following histologic parameters were registered: surface resorption, inflammatory resorption, replacement resorption (ankylosis), periapical inflammatory changes and downgrowth of pocket epithelium. Teeth autotransplanted to submucosal sites developed surface and inflammatory resorption. In half of the cases where teeth were transplanted with a vital periodontal ligaments new formation of bone took place adjacent to the transplant. Delayed replantation after submucosal burial was not found to inhibit the development of ankylosis, but changed the resorption type from direct apposition of bone upon the root surface to apposition of bone after initial resorption.

Animals↗
PubMed2002

[Hand replantation in an 88-year-old man: replanted senior?].

Indications of hand replantation need to take into account the patient overall condition and assess the magnitude of the injury. Although elderly people are usually considered as a limiting factor for microsurgery, indications of replantation may sometimes be extended. The author reports the case of a complete right hand amputation by a circular saw in an active right-handed 88 year man. The trans-carpal section was clean and general condition of the patient was satisfying. It was decided with the patient consent and the anaesthetist and the surgeon to perform the replantation. The procedure was carried on during 6 hours and revascularization took place 5 h 1/2 after injury. Post-operative period has been easy, but superficial nosocomial wound infection appeared which recovered with antibiotic therapy. It was not necessary to reoperate and the patient did not stay in intensive care department. After almost a 2 years follow-up, peripheral pulses were present, and the hand was warm and well coloured. Poor sensibility was found in median nerve area. Intrinsic motion was missing and extrinsic range of motion was weak. From a functional point of view, the patient was able to write, to dig his garden, and to drive his car. Analysis of this supposed hand replanted senior case report demonstrates that, when general and local conditions are safe, a hand replantation, even with a poor result, may be better than a prosthesis or an allograft, whatever the age of the patient.

Age Factors↗
PubMed1980

An overview of replantation and results of 347 replants in 245 patients.

A review of 245 patients requiring replantation surgery from 1970 to 1978 revealed a 70% survival rate for complete amputation. In this group, there were 347 replanted parts, including the lower extremity. Upper-extremity survival rates alone (greater than 90%) are higher than for lower extremity replantation. Meaningful assessment of replantation must include not only survival data but functional criteria as well. While functional data are incomplete on several early cases, our assessment criteria are reviewed. Criteria should include two-point discrimination sensibility ratings, grip strength, range of motion, absence of cold intolerance, and return to employment. Evaluation of candidates for replantation is critical, and the importance of teams with microsurgical skills working in special centers is emphasized.

Adult↗
PubMed1998

Rat tail replantation as a training model for microvascular procedures of digit replantation.

In this study we sought to evaluate the potential of rat tail replantation as a tool for very-small-vessel microvascular anastomoses. We used 10 adult Sprague-Dawley rats. The tail was completely amputated 2.0-cm distal to the base of the tail. Then the tail was replanted with anastomoses of two superficial dorsal veins from both sides and one artery. All 10 replanted tails were pink, viable, and normal-appearing at all daily inspections performed from the first to the fourteenth postoperative days. This model can provide a training tool for the acquisition of superior microvascular surgical technique for the repair of very small vessels that stimulate digital replantation.

Amputation, Traumatic↗
PubMed1977

Replantation of digits and hands: analysis of surgical techniques and functional results in 71 patients with 86 replantations.

Defining replantation as the restoration of a completely amputated part as opposed to simply restoring circulation to an incompletely severed part, the results of replantation of 86 completely amputated parts in 71 patients performed from January, 1970, to December, 1975, were studied. Twenty-eight, or 32.5 percent, were the result of sharp severances of the part; localized crushing accounted for 56, or 65.1 percent. Two were classified as degloving injuries. Twelve amputations were transmetacarpal, six were at the metacarpophalangeal joints, 14 through the proximal phalanx, 15 at the proximal interphalangeal joint, 21 in the middle phalanx, 13 at the distal interphalangeal joint, and five through the distal phalanx. The technique consisted of bone shortening and fixation and repair of all tendons and nerves if possible. Veins are repaired first, at least two for each artery, and heparinized saline and lidocaine are used locally. Irrigation of the vessels is not done, but an intravenous bolus of 3,000 U. of heparin is given when the anastomoses are completed. Aspirin and low molecular weight dextran are given for 3 to 7 days. For the more distal replantation, heparin may be used. Antibiotics are given. In the total series of 86 completely amputated hand units, 52 were unsuccessful, primarly due to vascular thrombosis and usually on the venous side. In the year 1975 a success rate of 69.2 percent was achieved, whereas in the last 50 replantations, done between Jan. 1, 1976, and Oct. 15, 1976, the success rate was 90 percent. Results improved with more experience in the technique and with more careful selection of patients.

Adolescent↗
PubMed1992

Staged major limb replantation: a concept to minimize the risk in replantation of the lower extremity.

The replantation of large limb segments presents two major problems: first, a general danger to survival because of major accompanying injuries and additional ischemia-reperfusion injury; second, local soft-tissue damage at the amputation site. Successful replantation can be compromised by infection, vessel thrombosis, and disturbed bone healing. Possible risk reduction may be accomplished by the concept of a two-staged replantation. A brief primary emergency procedure involving bone resection, osteosynthesis, and revascularization (with the goal of limb survival) is followed by a second procedure within 72 hr after trauma, for final debridement, completing the osteosynthesis, nerve and tendon suturing, and soft-tissue coverage by free flaps. The advantages of the double procedure are demonstrated in 27 patients by comparison of two treatment groups. Group I comprised 15 patients with definitive primary care. In Group 2 (n = 12), the two-stage operation was performed. The second group showed a shorter duration of overall treatment, reduction of blood loss, and fewer infections.

Adult↗
PubMed1978

Digit replantation. Analysis of 163 replantations in an 11 year period.

From July 1965 to June 1976, 163 digits in 107 patients were replanted, and 145 digits survived-an 89 per cent success rate. Critical analyses were made of the causes of failures, complications, bone union, sensory recovery, secondary reconstructive procedures, and the final outcome. The majority of the patients were satisfied with their replanted digits, and no reamputation because of uselessness or causalgic pain of the replanted part has been necessary.

Adolescent↗
PubMed1990

Epithelial rests' function in replantation: is splinting necessary in replantation?

The problem of resorption during replantation in relationship to the epithelial rests and a lack of splinting was studied. Ten mongrel dogs were used. Two dogs served as control subjects, while eight had their mandibular incisors intentionally replanted and studied histologically. It was observed that where rests of Malassez were present we did not see resorption, and the lack of splinting did not result in resorption or loss of teeth. It appears we can stain epithelial rests of Malassez with immunofluorescent antibodies and use this technique for further study of this tissue.

Animals↗
PubMed1979

Hand replantation in an 83-year-old woman--the oldest replantation?

A replantation of the hand was performed in an 83-year-old woman. There was good survival and the early functional return was satisfactory. However, after a personal tragedy and after the physiotherapy slowed down there was rapid deterioration in her hand function. Disuse atrophy became so marked after two years that the replanted hand became a stiff organ with little function.

Age Factors↗
PubMed1990

[Indications for replantation in psychiatric patients exemplified by hand replantation in a patient with schizophrenia].

After evaluating all criteria known about indications for replanting severed extremities, we found that mental retardation (with the exception of some conceivable isolated cases) and mental illness, i.e. psychosis, can no longer be considered absolute contraindications for replantation measures, due to the adequate therapeutic possibilities that are currently available.

Adult↗
PubMed1978

Replantation and revascularization of amputated parts of extremities: a three-year report from the Viennese replantation team.

A Replantation Team was instituted in Vienna 3 years ago. This team is the oldest in Europe. One hundred and eighty-one complete and incomplete amputated parts of 118 patients were replanted during this period. A survival rate of 86% and a useful functional result ("integrated parts") in 78% of the cases was obtained. Appropriate preparation of the amputated parts, the right timing, a 24 hour service and a clear indication with intensive postoperative physicotherapeutical treatment are the fundamental points for this result.

Amputation, Traumatic↗
PubMed1980

Functional results from replantation surgery: a five year report from the Viennese replantation team.

We present the results of treatment of completely and incompletely severed digits achieved by the Viennese Replantation Team. These results are regarded as comparable with other internationally reported series. Our extended use of vein and nerve grafts has effected an improvement in functional results and has made possible a more radical approach to severe hand injuries. We have also used composite and compound grafts for fingertip restoration, and utilized joint transplantation or transposition when necessary.

Austria↗