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Noh et al. Plast Aesthet Res 2020;7:50 Plastic and
DOI: 10.20517/2347-9264.2020.49 Aesthetic Research

Review Open Access

50+ years of replantation surgery experience: are we
progressing or regressing?

Karen Noh, Jacques H. Hacquebord

Department of Orthopaedic Surgery, NYU Langone Health, New York, NY 10014, USA.
Correspondence to: Dr. Jacques H. Hacquebord, Department of Orthopaedic Surgery, NYU Langone Health, 530 1st Avenue,
New York, NY 10016, USA. E-mail: Jacques.Hacquebord@nyulangone.org

How to cite this article: Noh K, Hacquebord JH. 50+ years of replantation surgery experience: are we progressing or regressing?
Plast Aesthet Res 2020;7:50. http://dx.doi.org/10.20517/2347-9264.2020.49

Received: 15 Mar 2020 First Decision: 12 Aug 2020 Revised: 21 Aug 2020 Accepted: 4 Sep 2020 Published: 17 Sep 2020

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

Abstract
The first successful digit replantation was reported in 1965 and accepted enthusiastically by hand surgeons. The
decade that immediately followed saw a surge of interest in this complex surgery, fueling significant improvements
in success rates and the rise of hand and microsurgeons who were highly proficient in replantation. The decades
that followed, however, showed a stable field lacking any significant changes or advancements. More recently,
and especially in the United States, the frequency with which surgeons even attempt replantation and the rate of
survival have plummeted. If this trend continues, successful replantation surgery will become all too rare of an
event. It is critical that we evaluate the state of replantation surgery today, identify the primary causes, and work
to not only revive the field but allow it to advance similar to other areas of medicine.

Keywords: Digit, replantation, amputation, hand surgery, microsurgery

INTRODUCTION
In 2017, 14.7% of primary diagnoses at emergency department visits in the United States were classified
[1]
as an injury to the wrist, hand, and fingers . Injuries to the hand and digits are exceedingly common - of
these, traumatic amputations of the digit are among the most severe injuries possible. The hand surgeon is
faced with two important options in treating this devastating injury: replantation or revision amputation.

Studies have demonstrated that replantation may be more desirable: a 2019 study reported significantly
better functional outcomes in patients with successful replantation than revision outcomes, as measured
© 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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