Secondary Procedures in Replantation

Abstract

The success of replantation surgery is not judged by survival of the replanted part, but by the functional outcome attained. Hence, primary repair of all injured structures is the preferred aim. At times, constraints induced by the ischemia time and nature of injury preclude primary repair. In such situations, secondary procedures are inevitable. Secondary procedures are also frequently required to improve the function and appearance of the replanted extremity. The incidence of secondary procedures will vary with the level of replantation and the type of patient population. Secondary procedures are difficult because they carry risk of injury to the vital neurovascular structures that now lay at nonanatomical locations. Nevertheless, when indicated and performed with caution they could significantly raise the functional status of the individuals.

Keywords

replantation - secondary surgery - tenolysis - hand amputation

• References

• 1 Wang H. Secondary surgery after digit replantation: its incidence and sequence. Microsurgery 2002; 22 (2) 57-61
• 2 Yu JC, Shieh SJ, Lee JW, Hsu HY, Chiu HY. Secondary procedures following digital replantation and revascularisation. Br J Plast Surg 2003; 56 (2) 125-128
• 3 Yaffe B, Hutt D, Yaniv Y, Engel J. Major upper extremity replantations. J Hand Microsurg 2009; 1 (2) 63-67
• 4 Schoeller T, Wechselberger G, Hussl H, Huemer GM. Functional transposition of the latissimus dorsi muscle for biceps reconstruction after upper arm replantation. J Plast Reconstr Aesthet Surg 2007; 60 (7) 755-759
• 5 Haas F, Hubmer M, Koch H, Scharnagl E. Immediate functional transfer of the latissimus dorsi myocutaneous island flap for reestablishment of elbow flexion in upper arm replantation: two clinical cases. J Trauma 2004; 57 (6) 1347-1350
• 6 Kawamura K, Yajima H, Tomita Y, Kobata Y, Shigematsu K, Takakura Y. Restoration of elbow function with pedicled latissimus dorsi myocutaneous flap transfer. J Shoulder Elbow Surg 2007; 16 (1) 84-90
• 7 Chuang DC, Lai JB, Cheng SL, Jain V, Lin CH, Chen HC. Traction avulsion amputation of the major upper limb: a proposed new classification, guidelines for acute management, and strategies for secondary reconstruction. Plast Reconstr Surg 2001; 108 (6) 1624-1638
• 8 Quaba AA, Elliot D, Sommerlad BC. Long term hand function without long finger extensors: a clinical study. J Hand Surg [Br] 1988; 13 (1) 66-71
• 9 Beris AE, Darlis NA, Korompilias AV, Vekris MD, Mitsionis GI, Soucacos PN. Two-stage flexor tendon reconstruction in zone II using a silicone rod and a pedicled intrasynovial graft. J Hand Surg Am 2003; 28 (4) 652-660
• 10 Sabapathy SR, Venkatramani H, Bharathi RR, Bhardwaj P. Replantation surgery. J Hand Surg Am 2011; 36 (6) 1104-1110
• 11 Pomerance J, Truppa K, Bilos ZJ, Vender MI, Ruder JR, Sagerman SD. Replantation and revascularization of the digits in a community microsurgical practice. J Reconstr Microsurg 1997; 13 (3) 163-170
• 12 Sabapathy SR, Venkatramani H, Bharathi RR, Dheenadhayalan J, Bhat VR, Rajasekaran S. Technical considerations and functional outcome of 22 major replantations (The BSSH Douglas Lamb Lecture, 2005). J Hand Surg Eur Vol 2007; 32 (5) 488-501
• 13 Jupiter JB, Pess GM, Bour CJ. Results of flexor tendon tenolysis after replantation in the hand. J Hand Surg Am 1989; 14 (1) 35-44
• 14 Whitaker JH, Strickland JW, Ellis RK. The role of flexor tenolysis in the palm and digits. J Hand Surg Am 1977; 2 (6) 462-470
• 15 Ünal MB, Cansü E, Parmaksizoğlu F. Lengthening of a thumb distal phalanx replanted to its metacarpus because of loss of the proximal phalanx: case report. J Hand Surg Am 2011; 36 (4) 661-664
• 16 Vucetic CS. Forearm elongation after hand replantation. A case report. J Bone Joint Surg Am 2005; 87 (1) 181-186