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Amputation and Replantation

Amputation vs replantation: patient selection, ischemia time limits, level-specific considerations, and post-operative rehabilitation.

Overview

Major limb replantation yields superior functional results compared to revision amputation and prosthesis fitting [1]. However, no data support definitive indications for limb salvage versus amputation [2]. Regardless of the treatment choice, patients with limb-threatening injuries sustain significant long-term disability [2]. For fingertip amputations, replantation offers better functional results than revision amputation but is more technically demanding, requires longer recovery time, and incurs higher costs [3]. It also necessitates microsurgical skill, longer surgery time, and a prolonged hospital stay [18]. Consequently, fingertip replantation is not routinely performed due to risks of failure [18]. Successful replantation remains an ideal treatment for fingertip amputation [18]. Replantation is favored for fingertip amputations distal to the DIP joint if feasible, offering superior functional and aesthetic outcomes compared to alternatives [45].

The decision to replant, revascularize, or amputate a nonviable digit depends on injury factors such as mechanism of injury, affected digit, and zone of injury [17]. The success of these procedures is related to the surgeon [17]. The amputated part should be examined carefully to eliminate rare conditions where replantation might not be the best option [4]. If replantation is not indicated, histopathological evaluation should be performed on the amputated part [4]. In the United States and Japan, the general public prefers replantation over wound closure for digit amputations [7].

For pediatric patients, replantation or revascularization of all completely or incompletely amputated parts in the upper extremity is advocated when technically possible [42]. This requires commitment from the child, parents, and surgeon regarding the expected result [42]. In complex cases, strategies such as shortening of the leg and later elongation may extend indications for lower extremity replantations in selected patients [22]. Additionally, the feasibility of gaining useful outcomes through secondary procedures like free functioning muscle transfer (FFMT) should encourage extending indications for replantation in avulsion amputations of the forearm [20].

Anatomy & Pathophysiology

Osseous and Joint Considerations

Accurate diagnosis and management of hand and carpal fractures and dislocations require a thorough physical examination and appropriate imaging to limit joint stiffness while preserving mobility and function [37]. Phalangization of the first and fifth metacarpals results in improvement in function [58]. In children following radial polydactyly reconstruction, high but physiological metacarpophalangeal joint mobility of the thumb must be considered when evaluating outcomes [48].

Soft Tissue and Reconstruction

Reconstruction is a better option than prosthesis fitting for mutilated hand management due to the ability to perform secondary procedures and increased hand use over time [53]. Hand surgery principles emphasize the balance between restoring function and maintaining aesthetic appearance [55]. Flexor tendon grafting using a plantaris tendon with a fragment of attached bone for fixation to the distal phalanx ensures immediate active motion and early use of the involved hand in daily activities [62]. Closed degloving of the thumb is a rare condition caused by crushing and elongation forces that detaches soft tissues without skin disruption [68].

Replantation and Transplantation Outcomes

Digit replantation does not restore premorbid hand function but results in adequate hand function [59]. Distal fingertip replants without heparin show favorable functional outcomes [69]. Replantation of an upper extremity proximal to the wrist joint satisfactorily restores upper extremity function [63]. Toe-to-hand transfers for thumb reconstruction result in improved strength and a reduced need for secondary surgery [41]. Three-dimensional computer-aided modeling and printing provide geometric accuracy in toe-to-hand transplantation [52]. In hand transplantation, the transplanted hand was functionally inferior to a mechanical prosthesis and never integrated into the patient's body image [65].

Prosthetics and Functional Restoration

Mechanical challenges in 3D-printed custom-designed prostheses for partial hand amputation include the need for solutions to minimize the force required at the wrist to activate grip [36]. Quantitative data demonstrates better hand performance when using a 3D-printed silicone-embedded prosthesis compared to not using any aid for partial hand amputation [56]. Preservation of wrist flexion and rotation is distinctly beneficial in upper-extremity amputation, with new devices allowing for forearm socket fabrication that preserves these motions without sacrificing prosthetic function [50]. The cineplastic muscle motor provides an excellent means for operating an artificial hand or hook [64].

Congenital and Neurological Pathology

Mirror hand-ulnar dimelia typically involves the entire upper limb, requiring treatment plans that consider predictors of function at each limb segment rather than just morphology [43]. In exploded hand syndrome, thumb ray dysfunction in sensibility and mobility remains the main functional disability despite generally good outcomes [47]. In surgical reconstructions for adult brachial plexus injuries involving combined C5 and C6 injuries, restoration of elbow flexion is the first priority, followed by shoulder motor function and stability, and then elbow, wrist, and finger extension if C7 root is involved [60].

Classification

Decision-Making Framework: The choice between replantation, revascularization, and amputation for nonviable digits depends on injury factors including mechanism, affected digit, and zone of injury [17]. Replantation success is also related to the surgeon [17]. No data support definitive indications for limb salvage versus amputation [2]. The decision is influenced by public preference; the general public in the United States and Japan prefers replantation over wound closure for digit amputations [7].

Outcome Comparison: Functional results after major limb replantation are better than those after revision amputation and prosthesis fitting [1]. Fingertip replantation offers better functional results than revision amputation [3]. However, replantation is more technically demanding [3] and requires a longer recovery time than revision amputation [3]. Regardless of treatment choice, patients with limb-threatening injuries sustain significant disability in long-term studies [2]. Early amputation seems to be better in cases of complications, despite similar quality of life in the two groups in the long-term [5]. Distal forearm-level replantation gives the best functional result of all levels of limb replantation [27].

Surgical Approach and Evaluation: The concept of treatment in stages is appropriate for amputations associated with extensive and complex injuries [40]. The amputated part should be examined carefully to eliminate rare conditions where replantation might not be the best option [4]. Histopathological evaluation should be performed if replantation is not indicated [4].

Philosophy and Alternatives: Amputation is a reconstructive procedure designed to help the patient create a new interface with the world and resume their life [46]. Amputation should never be viewed as a failure [46]. Hand transplantation is a reconstructive option for a small proportion of amputees who are sufficiently incapacitated [54]. Hand transplantation is not an alternative to prosthetic management for all amputees [54].

Other Considerations: A new classification system describes replantation as well as its complications and management [6]. The majority of amputations are preventable by provision of health education, early presentation, and appropriate management of common indications [11].

Clinical Presentation

History and Patient Preference: The general public in the United States and Japan prefers replantation over wound closure for digit amputations [7]. Psychosocial factors significantly influence outcomes in severe lower extremity trauma [33]. The perceived result of amputation is not associated with the amount of the limb that was amputated but rather with factors that may be optimized by surgical, prosthetic, and social management [19].

Inspection and Diagnostic Evaluation: The amputated part should be examined carefully to eliminate rare conditions where replantation might not be the best option [4]. Had fluorescein angiography evidence been heeded, three of seven failures of primary amputation and both failures of secondary amputation could have been prevented [14]. Histopathological evaluation should be performed on the amputated part if replantation is not indicated [4].

Functional Outcomes and Prognosis: Functional results after major limb replantation are better than revision amputation and prosthesis fitting [1]. Long-term studies show that patients with limb-threatening injuries sustain significant disability regardless of whether limb salvage or amputation is chosen [2]. Fingertip replantation offers better functional results than revision amputation but is more technically demanding and requires a longer recovery time [3]. Patients aged 4 or under and more distal amputations (level 1a injuries) are variables that predict an improved composite graft survival rate for digital tip amputation replacement in a pediatric population [34]. Resection-replantation with subsequent lengthening of the forearm causes less body image disturbance than does amputation [12]. Results from lower limb replantation cases provide hope to proceed with such procedures, although controversies exist [13].

Complications and Classification: Replantation and its complications are described using a new classification system [6]. Early amputation seems to be better in cases of complications, despite similar quality of life in the two groups in the long-term [5]. Stump problems secondary to traumatic lower limb amputation have a crucial influence on amputees' ability to return to living and work [31]. Appropriate evaluation and timely surgical revision of stump problems showed excellent results [31].

Decision-Making Axes: The guideline provides 11 evidence-based recommendations to aid decision-making for limb salvage versus early amputation in severe lower extremity trauma [33]. The guideline emphasizes that life should be prioritized over limb in severe lower extremity trauma [33]. Amputation can be considered an option to improve quality of life and relieve agonizing pain of severe, resistant complex regional pain syndrome (CRPS) at a specialized center after multidisciplinary involvement [30]. There are risks of aggravating or recurrence of CRPS, phantom pain, and unpredictable consequences of rehabilitation associated with amputation for CRPS [30].

Investigations

Clinical Assessment and Imaging: The amputated part requires careful examination to eliminate rare conditions where replantation might not be the best option [4]. In cases where replantation is not indicated, histopathological evaluation should be performed [4]. Fluorescein angiography provides critical vascular assessment; had surgeons heeded its evidence, three of seven failures of primary amputation and both failures of secondary amputation could have been prevented [14].

Functional Outcomes and Prognosis: Functional results after major limb replantation are better than revision amputation and prosthesis fitting [1]. Distal forearm-level replantation gives the best functional result of all levels of limb replantation [27]. The majority of zone I replantations led to satisfactory function on follow-up assessments [24]. Successful replantation for a radiocarpal joint amputation is associated with major restriction of motion, decreased strength, and moderate disability on functional outcome assessments [67]. Results achieved with lower limb replantation give hope to proceed with such procedures, although controversies exist [13].

Surgical Decision-Making and Alternatives: Replantation should be attempted in most cases, but osseointegration and other reconstructive options provide satisfactory results when replantation fails or is not possible [72]. Replantation should be undertaken even with an extremely shortened amputated digit because an efficient and reliable lengthening method is available [29]. In the setting of a posttraumatic digit with poor vascularization, it is possible to reverse impending necrosis by late revascularization [75]. Vessel transfers from the middle finger appear to be the most reliable solution for ring avulsion amputations [77], and the outcome of ring avulsion amputation cases demonstrates that replantation should be attempted [77]. Resection-replantation with subsequent lengthening of the forearm causes less body image disturbance than does amputation [12]. Ray amputation gave a measurable reduction in foot size with excellent functional results [44]. Early amputation seems to be better in cases of complications, despite similar quality of life in the two groups in the long-term [5]. Amputation had been considered for several patients before tibiofibular cross-peg grafting was performed [10].

Patient Preference and Practice Patterns: Hand amputee patients did not show a preference toward hand CTA with its inherent risks [70]. Two of every three patients did not undergo replantation surgery for finger amputations at a Level 1 Trauma Center [73].

Classification and Historical Context: A new classification system describes replantation as well as its complications and management [6]. Modern indications, techniques, and outcomes for replantation and revascularization in the hand include updated protocols and options for the most challenging cases [9]. Amputations in the Sixteenth Century were contaminated and grossly performed without vascular binding or wound closure [15].

Treatment

Non-Operative

Amputation should not be ignored as a treatment option for long-standing therapy-resistant Complex Regional Pain Syndrome Type I (CRPS-I) [57]. Early and temporary use of finger prosthetics is a relatively simple way to treat compensation or secondary pain during the healing process of an amputation [71].

Operative

Indications: No data support definitive indications for limb salvage versus amputation in mangled lower extremities [2]. Regardless of treatment choice, long-term studies show that patients with limb-threatening injuries sustain significant disability [2]. The decision to replant, revascularize, or amputate a nonviable digit is related to injury factors such as mechanism of injury, affected digit, and zone of injury [17]. The decision to replant, revascularize, or amputate a nonviable digit is also related to the surgeon [17]. The perceived result of amputation is not associated with the amount of the limb that was amputated [19]. The perceived result of amputation is associated with factors that may be optimized by surgical, prosthetic, and social management [19].

Surgical Approach / Technique: Replantation is more technically demanding than revision amputation [3]. Replantation requires microsurgical skill [18]. The amputated part should be examined carefully to eliminate rare conditions where replantation might not be the best option [4]. Histopathological evaluation should be performed if replantation is not indicated [4]. Successful execution of upper extremity amputations proximal to the finger allows maximum use of the residual extremity [61]. Successful execution of upper extremity amputations proximal to the finger minimizes complications [61]. Shortening of the leg and later elongation may extend the indications for lower extremity replantations in selected patients [22]. The feasibility of gaining useful outcome through secondary procedures like free functioning muscle transfer (FFMT) should serve as encouragement to extend the indications for replantation in avulsion amputations of the forearm [20].

Implant Selection: Bilateral hand transplantation is justified in cases of bilateral amputations with strict indications [32]. Transplantation for the loss of one hand is not indicated [32].

Pain Management: Successful replantation of single fingertip amputations resulted in minimal pain [35].

Adjuncts: Microsurgery has made replantation a routine procedure with reliable viability rates [38]. Achieving a satisfactory functional result after replantation is difficult and depends on a variety of factors [38].

Other Considerations: Fingertip replantation offers better functional results than revision amputation [3]. Replantation requires a longer recovery time than revision amputation [3]. Replantation requires longer surgery time [18]. Replantation requires prolonged hospital stay [18]. Replantation incurs higher cost [18]. Replantation is not routinely performed due to risks of failure [18]. Successful replantation is an ideal method for treatment of fingertip amputation [18]. Successful replantation of single fingertip amputations resulted in better functional outcome [35]. Successful replantation of single fingertip amputations resulted in better appearance [35]. Successful replantation of single fingertip amputations resulted in higher patient satisfaction [35]. The general public in the United States and Japan prefers replantation over wound closure for digit amputations [7]. The decision to amputate should be multidisciplinary, involving rehabilitation and orthotic specialists [21]. The decision to amputate requires long-term management and the fullest possible prior information for the patient [21]. A new classification system describes replantation as well as its complications and management [6]. The success of replantation and revascularization is related to both injury factors and the surgeon [17]. High-quality multicentre trials are needed to confirm findings regarding the Ganga Hospital Open Injury Severity Score for limb salvage versus amputation [39]. High-quality multicentre trials are needed to investigate the effectiveness of the Ganga Hospital Open Injury Severity Score in children [39]. High-quality multicentre trials are needed to investigate the effectiveness of the Ganga Hospital Open Injury Severity Score in predicting secondary amputations [39].

Complications

Replantation Risks and Resource Burden: Replantation is more technically demanding than revision amputation, requiring microsurgical skill [3, 18]. It involves longer surgery time, a prolonged hospital stay, and higher costs compared to revision amputation [3, 18]. Successful replantation carries inherent risks of failure [18], and consequently, replantation is not routinely performed due to these risks and resource requirements [18]. Furthermore, replantation requires a longer recovery time than revision amputation [3].

Limb Salvage vs. Amputation Outcomes: Limb-threatening injuries sustain significant disability regardless of whether limb salvage or amputation is chosen [2]. No data support definitive indications for choosing limb salvage versus amputation [2]. In the long term, quality of life is similar between amputation and limb salvage groups [5]. However, early amputation appears to be better in cases of complications [5].

Amputation Failure and Historical Context: Primary amputation failures can occur; in one study, seven failures were recorded, three of which fluorescein angiography could have prevented [14]. Secondary amputation failures can also occur; in the same study, two failures were recorded, both of which fluorescein angiography could have prevented [14]. Historically, amputations in the Sixteenth Century were contaminated and grossly performed without vascular binding or wound closure [15].

Other Considerations: Multi-limb amputees following a civilian earthquake have a high rate of reoperation [23]. This population also experiences substantial mortality [23] and limited functional recovery at two-year follow-up [23].

Recovery

Light activity (weeks): Evidence does not specify a discrete week range for light activity or desk work return in the provided data. However, fingertip replantation requires a longer recovery time than revision amputation [3]. For multi-limb amputees following the 2023 Türkiye earthquake, reoperation rates were high, indicating prolonged acute care needs [23].

Full activity (months): Specific month ranges for manual work or sport return are not defined in the available evidence. Long-term studies indicate that patients with limb-threatening injuries sustain significant disability regardless of whether limb salvage or amputation is chosen [2]. Multi-limb amputees from the 2023 Türkiye earthquake experienced limited functional recovery at two-year follow-up [23].

Complete recovery / outcome plateau (months): The evidence does not provide a specific month range for the stabilization of pain, strength, or final functional outcomes. Long-term studies show significant disability persists regardless of the chosen limb strategy [2].

Rehabilitation protocol: No specific rehabilitation protocols, immobilisation durations, or ROM progressions are detailed in the provided evidence.

Functional milestones: Functional results after major limb replantation are superior to revision amputation and prosthesis fitting [1]. Fingertip replantation offers better functional results than revision amputation [3]. Positive long-term results with high rates of subjective satisfaction are possible after upper extremity replantation [25]. Replantation of completely amputated thumbs using venous arterialization allows for good functional recovery with low risk and short operation time [78]. The functional outcome after amputation above a total knee replacement is very poor [49].

Other Considerations: Early amputation appears to be the better option in cases of complications, despite similar long-term quality of life between the two groups [5]. Delaying replantation of digits overnight yields results comparable to immediate replantation in selected cases [26]. Delayed and suspended replantations demonstrate results comparable to immediate replantation regarding graft survival and clinical outcome [74]. Gender and ischemia time have no significant influence on the survival rate of amputation replantation [66]. Composite grafts survive in the majority of patients, with a more significant survival pattern among younger populations and patients with more distal amputations [76]. Following revascularization, skin from a completely degloved finger survives in approximately two out of three cases [79].

Key Evidence

  • [L4] Functional results after a major limb replantation are better than revision amputation and prosthesis fitting. (10.1016/j.jhsa.2011.03.039)
  • [L5] Although fingertip replantation offers better functional results than does revision amputation, replantation is more technically demanding and requires longer recovery time. (10.5435/00124635-201312000-00006)
  • [L4] The amputated part should be examined carefully to eliminate rare conditions where replantation might not be the best option, and histopathological evaluation should be performed if replantation is not indicated. (10.1016/j.jhsa.2015.08.028)
  • [Paper] Early amputation seems to be better in cases of complications, despite similar quality of life in the two groups in the long-term. (10.1016/j.otsr.2017.05.022)
  • [L5] Using a new classification system, replantation as well as its complications and management is described. (10.1016/j.hcl.2015.01.006)
  • [L3] The general public in both countries prefer replantation over wound closure for digit amputations. (10.1016/j.jhsa.2015.05.026)
  • [L5] This issue presents modern indications, techniques, and outcomes for replantation and revascularization in the hand, with updated protocols and options for the most challenging cases. (10.1016/j.hcl.2019.01.005)
  • [L4] Amputation had been considered for several patients in this series before this operation was performed. (10.2106/00004623-197557050-00035)
  • [L4] The majority of these amputations are preventable by provision of health education, early presentation and appropriate management of the common indications. (10.1186/1749-799x-7-18)
  • [Case_report] Resection-replantation with subsequent lengthening of the forearm causes less body image disturbance than does amputation. (10.1016/j.jhsa.2014.03.030)
  • [L4] Results achieved with this patient give hope to proceed with lower limb replantations, although controversies exist. (10.1016/j.injury.2020.02.113)
  • [L4] Had the surgeon heeded the evidence of the fluorescein angiogram, three of the seven failures of primary amputation and both of the failures of secondary amputation could have been prevented. (10.2106/00004623-198264060-00010)
  • [L4] Amputations in the Sixteenth Century were contaminated and grossly performed without vascular binding or wound closure, consistent with the surgical knowledge of that period. (10.1186/1471-2474-15-301)
  • [L3] The decision to replant, revascularize, or amputate a nonviable digit and the success of replantation and revascularization are related to both injury factors, such as mechanism of injury, affected digit, and zone of injury, and the surgeon. (10.1007/s11552-013-9520-y)
  • [L5] Successful replantation is an ideal method for treatment of fingertip amputation, but it is not routinely performed due to risks of failure, need for microsurgical skill, longer surgery time, prolonged hospital stay, and higher cost. (10.1016/j.jhsa.2007.01.019)
  • [L3] The perceived result of amputation is not associated with the amount of the limb that was amputated but rather with factors that may be optimized by surgical, prosthetic, and social management. (10.2106/00004623-200008000-00004)
  • [L5] The feasibility of gaining useful outcome through secondary procedures like FFMT should serve as an encouragement to extend the indications for replantation in avulsion amputations of the forearm. (10.1016/j.injury.2019.10.059)
  • [L5] The decision to amputate should be multidisciplinary, involving rehabilitation and orthotic specialists, with long-term management and the fullest possible prior information for the patient. (10.1016/j.otsr.2017.12.001)
  • [Case_report] This strategy of treatment, shortening of the leg and later elongation, may extend the indications for lower extremity replantations in selected patients. (10.2106/00004623-199411000-00016)
  • [L4] This study presents one of the largest case series of multi-limb amputees following a civilian earthquake, highlighting the high rate of reoperation, substantial mortality, and limited functional recovery at two-year follow-up in this population. (10.1186/s13018-025-06231-y)
  • [L4] Follow-up assessments show that the majority of zone I replantations led to satisfactory function. (10.1016/j.jhsa.2008.05.005)
  • [L4] Positive long-term results with high rates of subjective satisfaction are possible after replantation of upper extremities. (10.1186/s12891-017-1442-3)
  • [L4] The results of delaying replantation of digits overnight give results comparable with those of immediate replantation in selected cases. (10.1016/j.jhsa.2018.03.047)
  • [Case_report] Even with an extremely shortened amputated digit, replantation should be undertaken because an efficient and reliable lengthening method is available. (10.1016/j.jhsa.2010.12.024)
  • [L4] Amputation can be considered by clinicians and patients as an option to improve quality of life and relieve agonizing pain of severe, resistant CRPS at a specialized centre after multidisciplinary involvement, but evidence is limited and there are risks of aggravating or recurrence of CRPS, phantom pain, and unpredictable consequences of rehabilitation. (10.1302/2058-5241.4.190008)
  • [L4] Stump problems secondary to traumatic lower limb amputation had crucial influence on amputees' ability to return to living and work, appropriate evaluation and timely surgical revision showed excellent results. (10.1186/s12891-015-0508-3)
  • [L5] Bilateral hand transplantation is justified in cases of bilateral amputations with strict indications, while transplantation for the loss of one hand is not indicated. (10.1054/jhsb.2001.0674)
  • [L2] The guideline provides 11 evidence-based recommendations to aid decision-making for limb salvage versus early amputation in severe lower extremity trauma, emphasizing that life should be prioritized over limb and that psychosocial factors significantly influence outcomes. (10.5435/jaaos-d-20-00188)
  • [L3] Patients aged 4 or under and more distal amputations (level 1a injuries) are variables that predict an improved graft survival rate. (10.1177/1753193415613667)
  • [L4] Mechanical solutions to minimize force required at the wrist to activate grip are still required. (10.1016/j.jht.2020.04.005)
  • [L5] While microsurgery has made replantation a routine procedure with reliable viability rates, achieving a satisfactory functional result is difficult and depends on a variety of factors. (10.5435/00124635-199803000-00004)
  • [L1] However, there is a need for high-quality multicentre trials to confirm these findings and investigate the effectiveness of the score in children, and in predicting secondary amputations. (10.1302/0301-620x.105b1.bjj-2022-0934.r1)
  • [L5] The concept of treatment in stages is appropriate for amputations associated with extensive and complex injuries. (10.2106/jbjs.c.01654)
  • [L4] Improved strength of thumb reconstructions and reduced need for secondary surgery was also displayed. (10.1016/j.jhsa.2011.04.010)
  • [L3] The authors advocate replantation or revascularization, when technically possible, of all completely or incompletely amputated parts in the upper extremity in children, provided that the child, the parents, and the surgeon are committed to the treatment in light of the expected result. (10.2106/00004623-199412000-00003)
  • [L4] Mirror hand-ulnar dimelia typically involves the entire upper limb, and treatment plans should consider predictors of function at each limb segment rather than just morphology. (10.1177/17531934221116960)
  • [L4] Ray amputation gave a measurable reduction in foot size with excellent functional results. (10.1302/0301-620x.97b10.35660)
  • [L5] Replantation is favored for fingertip amputations distal to the DIP joint if feasible, offering superior functional and aesthetic outcomes compared to alternatives. (10.1177/1753193419873555)
  • [L4] While general outcomes were good, thumb ray dysfunction in sensibility and mobility remained the main functional disability. (10.1177/1753193412468577)
  • [L2] High but physiological metacarpophalangeal joint mobility of the thumb needs to be taken into consideration when evaluating children following reconstruction. (10.1177/1753193415613583)
  • [L3] The functional outcome after amputation above a total knee replacement is very poor. (10.2106/00004623-200306000-00003)
  • [L4] Preservation of wrist flexion and rotation is distinctly beneficial, and new devices and techniques allow for the fabrication of forearm sockets that preserve these motions without sacrificing prosthetic function. (10.2106/00004623-195638060-00001)
  • [L4] Three-dimensional computer-aided modeling and printing provide geometric accuracy in toe-to-hand transplantation. (10.1016/j.jhsa.2021.09.034)
  • [L5] Reconstruction is a better option than prosthesis fitting due to the ability to perform secondary procedures and increased hand use over time. (10.1177/17531934211047760)
  • [Commentary] Hand transplantation is a reconstructive option for a small proportion of amputees who are sufficiently incapacitated, rather than an alternative to prosthetic management for all. (10.1177/1753193414568052)
  • [Case_report] Quantitative data demonstrates better hand performance when using 3D printed silicone-embedded prosthesis vs not using any aid. (10.1016/j.jht.2017.10.001)
  • [L4] However, amputation should not be ignored as a treatment option for long-standing therapy-resistant CRPS-I. (10.2106/jbjs.m.00788)
  • [L1] Digit replant does not restore premorbid hand function but does result in adequate hand function. (10.1177/1558944719834658)
  • [Paper] Restoration of elbow flexion is the first priority, followed by shoulder motor function and stability, and then elbow, wrist, and finger extension if C7 root is involved. (10.1016/j.injury.2020.02.076)
  • [L5] The article reviews current surgical options for performing and managing upper extremity amputations proximal to the finger, emphasizing that successful execution allows maximum use of the residual extremity and minimizes complications. (10.1016/j.jhsa.2011.07.025)
  • [L4] The tendon-bone plantaris graft employed here ensured immediate active motion and early use of the involved hand in daily activities. (10.1016/j.jhsa.2007.08.022)
  • [L4] Replantation of an upper extremity proximal to the wrist joint satisfactorily restored the upper extremity function. (10.1177/1753193411427228)
  • [L4] The cineplastic muscle motor provides an excellent means for operating an artificial hand or hook. (10.2106/00004623-195133030-00007)
  • [L4] The transplanted hand was functionally inferior to a mechanical prosthesis and never integrated into the patient's body image. (10.1054/jhsb.2001.0697)
  • [L5] Gender and ischemia time had no significant influence on the survival rate of amputation replantation. (10.1177/1753193415594572)
  • [L4] Successful replantation for a radiocarpal joint amputation is associated with major restriction of motion, decreased strength, and moderate disability on functional outcome assessments. (10.1016/j.jhsa.2014.10.017)
  • [L4] Closed degloving of the thumb is a rare condition caused by crushing and elongation forces that detaches soft tissues without skin disruption. (10.1016/j.jhsa.2007.06.016)
  • [L4] This study suggests favorable functional outcomes for distal fingertip replants without heparin. (10.1016/j.jhsg.2024.02.018)
  • [L2] Hand amputee patients did not show a preference toward hand CTA with its inherent risks. (10.1016/j.jhsa.2014.08.048)
  • [L4] This treatment technique is a relatively simple way to treat compensation or secondary pain during the healing process of an amputation. (10.1016/j.jht.2010.04.003)
  • [L5] Replantation should be attempted in most cases, but osseointegration and other reconstructive options provide satisfactory results when replantation fails or is not possible. (10.1177/17531934221085806)
  • [L4] Two of every three patients did not undergo replantation surgery. (10.1016/s0363-5023(09)60136-2)
  • [L4] Delayed and suspended replantations demonstrate results comparable to immediate replantation regarding graft survival and clinical outcome. (10.1016/j.jhsa.2015.01.006)
  • [Case_report] In the setting of a posttraumatic digit with poor vascularization, it is possible to reverse impending necrosis by late revascularization. (10.1016/j.jhsa.2008.11.020)
  • [L1] The composite graft survived among the majority of the patients, with a more significant survival pattern among younger populations and patients with more distal amputations. (10.1186/s13018-024-05230-9)
  • [L4] Vessel transfers from the middle finger appear to be the most reliable solution, and the outcome of the cases demonstrates that replantation should be attempted. (10.1016/j.jhsa.2013.02.014)
  • [L4] The method allows replantation of completely amputated thumbs that was previously considered impossible, with low risk, short operation time, and good functional recovery. (10.1016/j.jhsa.2007.05.011)
  • [L4] Following revascularization, the skin from a completely degloved finger will survive in approximately two cases out of three. (10.1177/1753193417724680)

See Also

References

[1] Replantation Surgery. The Journal of Hand Surgery. 2011. DOI: 10.1016/j.jhsa.2011.03.039

[2] Chapter 15 The Mangled Lower Extremity. 2021.

[3] Fingertip Injuries: An Update on Management. Journal of the American Academy of Orthopaedic Surgeons. 2013. DOI: 10.5435/00124635-201312000-00006

[4] Melanoma in an Amputated Fingertip. The Journal of Hand Surgery. 2015. DOI: 10.1016/j.jhsa.2015.08.028

[5] Is amputation a viable treatment option in lower extremity trauma?. Orthopaedics & Traumatology: Surgery & Research. 2017. DOI: 10.1016/j.otsr.2017.05.022

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