Professional Documents
Culture Documents
Re Implantation and Micro Surgical Techniques
Re Implantation and Micro Surgical Techniques
microsurgical
techniques
Reimplantation
Definition: Preserve and
surgically reattach
amputated
extremity/digit
Aim: Restoration of
function and cosmesis
Historical
Malt(1962): Massachusetts first
reimplantation of severed arm
Chen (1962) Shanghai, China first hand
reimplantation
Emerging microsurgical technology
Kleinert (1966), revacularised thumb
Komatsui(1968), thumb reimplantation
Factors related to outcome
Level of amputation: proximal v distal
Mechanism of injury: Guillotine v crush
Contamination of wound
Age of patient
Ischaemia time
Delay to theatre
Smoking/caffeine/diabetes
Patient motivation/expectations/compliance
Level of amputation
Transhumeral, elbow,
mid forearm most
favourable outcome
Distal tip amputations
fare worse
Thumb attempt at
reimplantation/toe
transfer
Level of amputation
Multiple digit loss-
aim to have at least
pincer grasp(thumb-
index/middle)
Aim for power grip
(ring/small)
May require
autogenous salvage
harvest from
amputated extremity
Mechanism of injury
Sharp, clean, guillotine
amputations most
favourable outcome
Compounded by thermal,
chemical injury
Age related factors
Children best outcome:though technical difficulty
operatively.
Psychological counselling
Summary
Reimplantation successful procedure
Careful pre-op assessment and case
selection required
Outcome influenced many factors
Importance of rehabilitation
Aim to preserve function and cosmesis
Thank you