Replantation
Encyclopedia
Replantation is the surgical reattachment of a body part by microsurgical means, most commonly a finger
, hand
or arm
, that has been completely cut from a person's body. Replantation of amputated
parts has been performed on fingers, hands, forearm
s, arms, toes, feet, legs, ear
s, avulsed
scalp
injuries, a face, lips, penis
and a tongue
.
The first replantation peformed in the world with microvascular repair of vessels was done by a team of chief residents led by Dr. Ronald Malt at Massachusetts General Hospital in Boston, MA, USA in 1962. The arm of a 12 year old child severed at the level of the proximal humerus was reattached. The first report of a replantation published in a peer reviewed medical journal was reported by a team led by Zhong Wei Chen of the Sixth People's Hospital in Shanghai in 1963 writing in the Chinese Medical Journal. A machinist's hand was reattached at the level of the distal forearm. In this case vascular couplers were used for the vessels as the Chinese did not have good micro sutures available at that time. As there was little communication between China and the Western World in those years, Ronald Malt and Charles McKhann published in JAMA in 1964 their first two replantations without referencing the earlier published article from China.
Replantation requires microsurgery
and must be performed within several hours of the part's amputation at a center with specialized equipment, surgeons and supporting staff. To improve the chances of a successful replantation, it is necessary to preserve the amputate as soon as possible in a cool(close to freezing, but not at or below freezing) and sterile or clean environment. Parts should be wrapped with moistened gauze and placed inside a clean or sterile bag floating in ice water. Dry ice should not be used as it can result in freezing of the tissue. There are so called sterile "Amputate-Bags" available which help to perform a dry, cool and sterile preservation.
Parts without muscles such as fingers can be preserved for many hours, while major muscled containing parts such as arms need to be re attached and revascularized within 6-8 hours to survive. Outcome of major limb replantations can be predicted by the potasium level of the blood which flows out of the replanted part after revascularization as a high level can be a marker of muscle and tissue death.
It is important to also collect and to preserve those amputates which do not look like being "replantable". A microsurgeon needs all available parts of human tissue to cover the wound at the stump and thus to prevent further shortening of the stump. In some cases (e.g. forearm) the task of an important joint (e.g. elbow) can be conserved for improved prosthetic success.
Severe crush injuries, multilevel injuries, avulsion injuries, and in some cases jagged tearing of tissue, can preclude replantation and salvage, requiring revision amputation of the stump.
Finger
A finger is a limb of the human body and a type of digit, an organ of manipulation and sensation found in the hands of humans and other primates....
, hand
Hand
A hand is a prehensile, multi-fingered extremity located at the end of an arm or forelimb of primates such as humans, chimpanzees, monkeys, and lemurs...
or arm
Arm
In human anatomy, the arm is the part of the upper limb between the shoulder and the elbow joints. In other animals, the term arm can also be used for analogous structures, such as one of the paired forelimbs of a four-legged animal or the arms of cephalopods...
, that has been completely cut from a person's body. Replantation of amputated
Amputation
Amputation is the removal of a body extremity by trauma, prolonged constriction, or surgery. As a surgical measure, it is used to control pain or a disease process in the affected limb, such as malignancy or gangrene. In some cases, it is carried out on individuals as a preventative surgery for...
parts has been performed on fingers, hands, forearm
Forearm
-See also:*Forearm flexors*Forearm muscles...
s, arms, toes, feet, legs, ear
Ear
The ear is the organ that detects sound. It not only receives sound, but also aids in balance and body position. The ear is part of the auditory system....
s, avulsed
Avulsion injury
In medicine, an avulsion is an injury in which a body structure is forcibly detached. It most commonly refers to a surface trauma where all layers of the skin have been torn away, exposing the underlying structures...
scalp
Scalp
The scalp is the anatomical area bordered by the face anteriorly and the neck to the sides and posteriorly.-Layers:It is usually described as having five layers, which can conveniently be remembered as a mnemonic:...
injuries, a face, lips, penis
Penis
The penis is a biological feature of male animals including both vertebrates and invertebrates...
and a tongue
Tongue
The tongue is a muscular hydrostat on the floors of the mouths of most vertebrates which manipulates food for mastication. It is the primary organ of taste , as much of the upper surface of the tongue is covered in papillae and taste buds. It is sensitive and kept moist by saliva, and is richly...
.
The first replantation peformed in the world with microvascular repair of vessels was done by a team of chief residents led by Dr. Ronald Malt at Massachusetts General Hospital in Boston, MA, USA in 1962. The arm of a 12 year old child severed at the level of the proximal humerus was reattached. The first report of a replantation published in a peer reviewed medical journal was reported by a team led by Zhong Wei Chen of the Sixth People's Hospital in Shanghai in 1963 writing in the Chinese Medical Journal. A machinist's hand was reattached at the level of the distal forearm. In this case vascular couplers were used for the vessels as the Chinese did not have good micro sutures available at that time. As there was little communication between China and the Western World in those years, Ronald Malt and Charles McKhann published in JAMA in 1964 their first two replantations without referencing the earlier published article from China.
Replantation requires microsurgery
Microsurgery
Microsurgery is a general term for surgery requiring an operating microscope. The most obvious developments have been procedures developed to allow anastomosis of successively smaller blood vessels and nerves which have allowed transfer of tissue from one part of the body to another and...
and must be performed within several hours of the part's amputation at a center with specialized equipment, surgeons and supporting staff. To improve the chances of a successful replantation, it is necessary to preserve the amputate as soon as possible in a cool(close to freezing, but not at or below freezing) and sterile or clean environment. Parts should be wrapped with moistened gauze and placed inside a clean or sterile bag floating in ice water. Dry ice should not be used as it can result in freezing of the tissue. There are so called sterile "Amputate-Bags" available which help to perform a dry, cool and sterile preservation.
Parts without muscles such as fingers can be preserved for many hours, while major muscled containing parts such as arms need to be re attached and revascularized within 6-8 hours to survive. Outcome of major limb replantations can be predicted by the potasium level of the blood which flows out of the replanted part after revascularization as a high level can be a marker of muscle and tissue death.
It is important to also collect and to preserve those amputates which do not look like being "replantable". A microsurgeon needs all available parts of human tissue to cover the wound at the stump and thus to prevent further shortening of the stump. In some cases (e.g. forearm) the task of an important joint (e.g. elbow) can be conserved for improved prosthetic success.
Severe crush injuries, multilevel injuries, avulsion injuries, and in some cases jagged tearing of tissue, can preclude replantation and salvage, requiring revision amputation of the stump.