Microvascular Complications of Replantations of the Upper Extremity

Abstract

Over a fifteen-year period (1986-2000), 336 patients in a single center received microvascular repair for devascularizing upper extremity injury. In 187 patients, this involved a reattachment of an amputated part while a revascularization was required in 172 patients. In 23 patients, the microvascular repair was located proximal to the wrist level and in 313, distal to the wrist. Vascular complications occurred in 61 patients (7 proximal to and 54 distal to the wrist). In 40 % of the cases, the original injury involved extensive soft tissue compromise, including a circular saw in 37, avulsion injuries in 15, crush in 6, and a blast, gunshot, and a road traffic accident in one each. Vascular occlusions involved 34 arterial repairs and 22 venous repairs, while flow could not be reestablished in 4, and a heparin-induced thrombocytopenia in one. Fifty percent of occlusion occurred within the first 36 hours and 90 % within the initial four days. The vascular thrombosis was treated operatively in 39 patients and with medication in 22. Successful reestablishment of flow was accomplished in 33 patients (55 %). In our experience, the vascular occlusion proved to be the most common postoperative complication.

Replantation - Upper extremity - Vascular complications

References

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