Replantation and revascularization of the upper extremity: clinical experience of a microsurgical department in Portugal

Background Since the pioneering works of Malt and Komatsu and Tamai in the 1960s, thousands of replantations and revascularizations of the upper extremity have been performed worldwide. The advent of microsurgery allowed surgeons to replant or revascularize essentially any amputated part. However, the mechanism of injury or patient comorbidities are important factors that can affect the outcomes. Methods Patients submitted to upper extremity replantation or revascularization between 2014 and June 2018 were retrospectively analyzed. Demographic features, type of accident, mechanism of injury, amputation level, and success rate were examined. Results Over the 4.5-year period, 45 replantations and 20 revascularizations were performed. The vast majority of patients were male. The mean age was 45.7 years old in the replantation group and 49.2 years old in the revascularization group. In both groups, the crush/avulsion injury was the most common mechanism. The overall success rate was 57.8% in replantation and 75% in revascularization. The failure in the replantation group was mainly due to arterial insufficiency. Conclusions The success of revascularization is higher than replantation; however, the mechanism of injury seems to be a critical determinant of the outcome. Level of Evidence: Level IV, therapeutic study.