The problems of limb replacement

McNeill, I. F.; Wilson, J.S.P.

doi:10.1002/bjs.1800570513

Cited by 42 publications

(6 citation statements)

References 23 publications

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“…In general, the high biological potential of young patients makes it possible and reasonable to broaden the scope of the indications for replantation of major segments of the extremities in children. 15,19 The case presented here demonstrates the important impact of successful replantation surgery for normal social and psychological development of a child.…”

Section: Discussionmentioning

confidence: 86%

“…4,13,14 Second, in lower-extremity replantations, factors such as limb shortening and limb length discrepancy are much more significant in determination of the functional outcome than in cases of upper-extremity replantations. [15][16][17] Meanwhile, successful outcome of replantation, both survival and long-term functional result, is impossible without radical excision of damaged (crushed) tissues. This inevitably leads to considerable shortening of the extremity.…”

Section: Discussionmentioning

confidence: 99%

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Simultaneous Replantation of Both Lower Legs in a Child: 23 Years Later

Datiashvili

2009

J reconstr Microsurg

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Function is the single most important determinant in the assessment of the results of extremity replantations. Accordingly, the indications for extremity replantations are based on the prediction of sustained satisfactory functional outcome. There are limited reports in the literature regarding replantations of major segments of lower extremities and, particularly, long-term results of those surgeries. However, this analysis is extremely important in refinement of indications for major limb replantations. In this article, evaluation of a patient 23 years after simultaneous replantation of both lower legs is presented.

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Section: Discussionmentioning

confidence: 86%

Section: Discussionmentioning

confidence: 99%

Simultaneous Replantation of Both Lower Legs in a Child: 23 Years Later

Datiashvili

2009

J reconstr Microsurg

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“…11 Reperfusion of the leg following warm ischemia of more than 4À6 h usually results in autolysis and necrosis. It was suggested that an ischemia warm time of more than 10 h precludes replantation attempts.…”

Section: Discussionmentioning

confidence: 99%

Replantation of a crush amputation of distal tibia followed by lengthening with Ilizarov circular external fixator: Two‐year follow‐up

Nişancı

Yıldız

et al. 2002

Microsurgery

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A 20-year-old male sustained a severe crush injury to his left leg, resulting in amputation of the foot at the level of the distal tibia. Despite 12-h warm ischemia, replantation was attempted after radical debridement, bone shortening, and proximal fasciotomies. The replanted part survived totally. Four months later, a 13-cm shortness of the extremity was managed by 10-cm lengthening with distraction osteogenesis, using Ilizarov's circular external fixator and by means of a special shoe. Two-year follow-up of the patient revealed acceptable functional and sensorial recovery. Success of replantation despite the excessive warm-ischemia time was attributed to the sparse muscle content of the distal tibia and foot. Fasciotomies performed on the proximal segment of the leg ensured the patency of anastomoses by maintaining adequate blood flow distally despite increasing edema after the crush injury. Debridement and bone shortening at the proximal stump eliminated the vein and nerve grafts to bridge the gap. In conclusion, considering the functional outcome of our case, replantation of distal parts of a lower extremity should be attempted first, even if the nature of the injury is unfavorable and the ischemia time is longer than the documented ischemia-tolerance.

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“…5 Upper limb Russell et al,8 in Australia, studied the functional results of 25 patients after successful upper limb revascularization or replantation. The injured arm, as well as the unaffected arm, was tested using a standard format, by the same surgeon and occupational therapist.…”

Section: Tbethumbmentioning

confidence: 98%

Upper Limb Replantation: Does the Patient Benefit?

Garner

1988

British Journal of Occupational Therapy

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Although the operations to reattach amputated limbs are, without doubt, great technical achievements, it could be argued that the patient may be more handicapped, in some instances, with a replanted upper extremity than with an amputation. The literature reviewed in this article indicates that there is no guarantee that a replanted limb will have good functional recovery. However, the evidence is not conclusive that, in the majority of cases, amputation is preferable to replantation.

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The problems of limb replacement

Cited by 42 publications

References 23 publications

Simultaneous Replantation of Both Lower Legs in a Child: 23 Years Later

Simultaneous Replantation of Both Lower Legs in a Child: 23 Years Later

Replantation of a crush amputation of distal tibia followed by lengthening with Ilizarov circular external fixator: Two‐year follow‐up

Upper Limb Replantation: Does the Patient Benefit?

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