Fifty years of experience with upper limb replantation in a single center of Medellín, Colombia

Abstract

Introduction

The first upper limb replantation was done by Drs. Malt y McKahn in Boston, MA in 1962 and was published in 1964. Then, Dr. C.W. Ch’en in 1963 reported a hand replantation. The first hand replantation done by our service in 1964 was published along with other five cases in 1967 by Ramirez et al. This report wants to show the experience of a single centre of 50 years with a series of more than 200 replanted patients.

Materials and methods

We reviewed the available statistics of our service form the last fifty years and we found XX patients who went on replantation of digits, hands or upper limbs. We describe the demographics, mechanism of trauma, conditions of transport of both patients and amputated segments and the surgical technique used in the earlier years.

Results

In total, we have replanted 250 segments in 50 years, most of the patients amputated by clean cut in the distal left forearm or hand. The majority of patients are young men with little or no morbidities and were remitted from rural territories six hours away or even more of our centre.

Discussion

We report a large serie of major replants associated with the extended use of “machete” in our culture. Like in other reports, our series also shows that in the later years indications of replantation had expanded to included amputated segments by other mechanisms such as occupational accidents, explosive trauma and motor vehicle accidents that are increasingly referred to us. After the introduction of microsurgery and the experience gained, the salvage rate has improved and functional results of replanted limbs have ameliorated.

Conclusions

Replantation of a severed limb is now a well known and a routine procedure practiced in our centre with 50 years of transmitted experience from old to new surgeons with excellent functional results ameliorated by the introduction of microsurgical technique more than 30 years ago.