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Luthringer et al. Plast Aesthet Res 2020;7:42 Plastic and
DOI: 10.20517/2347-9264.2020.35 Aesthetic Research

Review Open Access

Major upper limb replantation: a review of clinical
pearls

Margaret Luthringer, Margaret Dalena, Haripriya S. Ayyala

Division of Plastic and Reconstructive Surgery, Rutgers-New Jersey Medical School, Newark, NJ 08873, USA.
Correspondence to: Dr. Haripriya S. Ayyala, Division of Plastic and Reconstructive Surgery, Rutgers-New Jersey Medical School,
140 Bergen St, Suite E1620, Newark, NJ 08873, USA. E-mail: ha289@njms.rutgers.edu

How to cite this article: Luthringer M, Dalena M, Ayyala HS. Major upper limb replantation: a review of clinical pearls. Plast
Aesthet Res 2020;7:42. http://dx.doi.org/10.20517/2347-9264.2020.35

Received: 11 Mar 2020 First Decision: 22 May 2020 Revised: 3 Jul 2020 Accepted: 20 Jul 2020 Published: 15 Aug 2020

Academic Editor: A Thione Copy Editor: Cai-Hong Wang Production Editor: Jing Yu

Abstract
Replantation of major segments of the extremities can be a formidable task. Adequate debridement of crushed
tissues is a prerequisite for successful major limb replantation. This article serves to elucidate the important
situational and patient factors a surgeon must consider when choosing between replantation or revision
amputation for upper limb salvage.

Keywords: Limb salvage, major limb replantation, microsurgery, upper extremity, reconstruction

INTRODUCTION
Since Malt and McKhan’s first successful upper extremity replantation in 1962, ever-evolving surgical
[1]
techniques have redefined outcomes for patients with these life-altering injuries . Still, these cases remain
a challenge for surgeons who must make difficult decisions regarding replant candidacy and surgical
options. In 2005, approximately 170,000 people in the United States were living with a wrist-proximal
upper extremity amputation. Young males are predominantly affected; trauma remains the leading cause
[2]
of injury in this group . Though prosthetic options for upper extremity amputation have significantly
[3]
improved in recent years, rejection rates of devices have been described to be as high as 30% . Further,
post-operative functionality can be unpredictable. Upper limb replantation continues to yield better overall
subjective results over revision amputation . This article serves to review the important situational and
[3]
patient factors a surgeon must consider when choosing between replantation or revision amputation for

© The Author(s) 2020. Open Access This article is licensed under a Creative Commons Attribution 4.0
International License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use,
sharing, adaptation, distribution and reproduction in any medium or format, for any purpose, even commercially, as long
as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license,
and indicate if changes were made.

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