Replantation of untidily amputated finger, hand, and arm: experience of 99 replantations in 66 cases.

Three problems the authors think important in replantation of untidy amputations are discussed based on our 99 replantations with the success rate of 92.6% over a 4-year period. To restore circulation in this type of amputation, such techniques as transfer of blood vessels, use of a neurovascular island flap with neurovascular anastomoses at its distal margin, vein graft, and free split-skin graft directly on the anastomosed blood vessels are recommended. Recovery of tendon gliding when replanted proximally to the MP joint was reasonably good but not when replanted distally to it. Recovery of intrinsic muscles was generally poor. Protective sensation was usually regained, although occasionally accompanied by paresthesia. Amputation of single digit was found not to be an absolute indication for replantation except for the thumb. In multiple digital amputation, more important digits should be restored by amputated digits in better condition. Replantation for cosmetic improvement may be justified in such cases as unmarried young females. In infants, replantation is especially worthwhile because good functional recovery and good further growth can be expected.