Maximising the outcomes of proximal upper limb replantation

Published Date: 14th August 2018

Publication Authors: Alfeky H

​Aim

Proximal hand and forearm amputations are devastating injuries, the prediction of the success is always uncertain due to multi factorial risk factors including the mode of injury, level of amputation, presence of contamination and the extent of the damage to the neuro-vascular tree. General patient status and co-morbidities affect the outcomes as well. There is not any reported algorithm or guidance that can help predict the outcomes of plantation.

Methods

We present our experience of a series of 17 post traumatic proximal hand and forearm replantations over a 5 year period in 3 major trauma centres.

Results

A management guidance is proposed to help deciding whether the process will be successful regarding the immediate survival and the long term functional outcomes and cost effectiveness.

Conclusion

If planned well and done only when success is predicted, proximal replantation is very rewarding and even can do better than distal replantation. We propose an algorithm to help surgeons detect the outcome and the cost-effectiveness of proximal replantations.

 

Taman, E; Alfeky, H; Omran, A; Swilam, M; Elshahat, M. (2018). Maximising the outcomes of proximal upper limb replantation. International Journal of Surgery. 55 (Suppl 1), S116

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