Slovenská chirurgia 1-2e/2024

Amputation injuries in the hand, preoperative management and indications for replantation procedures

The possibility of replanting amputated limbs has fascinated surgeons since time immemorial. With the construction of the operating microscope in the early 20th century and the production of microsurgical suture material of sufficiently small diameter in the second half of the 20th century, the first replantations in the hand at the microsurgical level were made possible. Already in the early years of successful hand and finger replantations, once their expected functional results were understood, indication criteria were formed that are more or less still valid today. By refining the microsurgical technique and following the indications, success rates of 70 – 90 % have gradually been achieved. In addition to its flawless execution and adequate postoperative care, the initial management from trauma to transport to the replantation centre is equally important for the success of the replantation procedure. In the following article, we attempt to provide the general surgical public with basic information and rationale for the indications and contraindications of hand replantation procedures and their proper management from the initial contact with the medical professional to transport to the replantation centre.

Keywords: replantation, revascularization, hand, fingers, indication criteria, transport, preoperative management