Replantation

Clinical replantation has more than 50 years of history now. Yet there are still many new developments worthy of a special issue of Seminars on this topic.

Replantation still remains the best form of reconstruction following the amputation of a body part. Over the years, techniques have been refined to make the procedure quicker—and with better outcomes. In practice, the number of replantations performed has actually been reduced in some parts of the world, which can be attributed to the enforcement of safety standards. With less patients requiring the surgery, there is a need to refresh various aspects of replantation surgery so that when a patient does require it, the team is at its best.

However, in other parts of the world, we have also seen an extension of indications for replantations, particularly in fingertip and major amputations. Distal replants, though technically challenging, offer a good outcome. Similarly, there does not seem to be a better answer than replantation for major amputations. Though the procedure may be complex, it still offers a better outcome than the best available prosthesis, and secondary procedures can improve function. Good outcome analysis is needed to put these indications and procedures in the right perspective.

One topic that continually comes up in peer discussion on replantation surgery is the need to keep the team's microsurgical skill levels high. Repetition is the mother of skill. Units that regularly do single-finger replants distal to the proximal interphalangeal joint will be better equipped to take on multiple finger amputations in a child or the replantation of an avulsed thumb. Familiarity with the subject increases confidence and lowers the threshold to do the procedure.

The demands on the infrastructure, operation theater time, and on the skills and availability of the surgeon to perform a replant have not changed over the past 50 years. In the same way, the joy of the patient and the gratitude they express following successful replantation has also not changed over this period. Patients still rate a successful replant as a surgical miracle. After all these years, replantation still makes news!