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Major Limb Replantation

Replantation of limbs proximal to the wrist is called major replantation. Since these amputated parts contain lot of muscle, replantation must be done quickly. Muscles degrade fast without blood supply. When done later the degradation products upon entering the general circulation could cause potentially life threatening situations.

Speed is the key in performing major Replantation.

Ganga Hospital has significantly contributed to the science and techniques of major replantations and have evolved guidelines for performing this challenging procedure which is widely followed. LINK TO DOUGLAS LAMB ARTICLE

Major Replantations can be divided into three types based on the level of amputation.

Mid Arm Level & above

At this level the muscle mass in the limb is more and therefore time is at a premium and Replantation has to be carried out within 4-6 hours from injury. The decision to replant depends upon nature of injury, age of the patient and the extent of damage to the part.

A mid arm level amputation successfully reattached. Forearm muscles recovered producing useful flexion of fingers and wrist. Later he underwent tendon transfer for wrist extension making him functionally independent.

Lower third of arm to middle of forearm

Amputations close to the elbow are technically more difficult to replant because of elbow joint and the muscles which move the fingers that originate near the elbow joint make it difficult to radically shorten the bone. With adequate amount of bone shortening and removal of the damaged muscles, we can attempt replantation safely from 6-8 hours from injury.

A proximal forearm avulsion amputation due to an industrial accident

Mid forearm to wrist level

In this level the amputated part contains very little of muscle. It is easier to join the tendons and nerves. Since the muscles are intact with nerve supply, functional outcome of replantations at this level are very good. When the amputated part is properly stored replantations could be done even with 8-10 hours of ischemia.

A wrist amputation due to an industrial accident