REPLANTATION VON EXTREMITATENTEILEN. INDIKATION, TECHNIK, ERSTE ERGEBNISSE

Large-scale replantations proximal to the wrist joint should be differentiated from small-scale replantations distal to the wrist joint. In large-scale replantations, the time interval is decisive, there is considerable risk of renal damage and infarction, but the technical difficulties of operating are few. Small-scale replantations occur 20 times more frequently. The replantability of the amputated extremity lasts up to 25 hours if cooled. Microvascular surgery is decisive in small-scale replantations. The first measures of cleansing and dressing should be only sterile bandaging of the wound and cooling of the amputated extremity. Conservative wound excision is indicated. The replantation proper begins with osteosynthesis, using wire fixation. Then follows the suturing of the lower flexor tendon and the tendon sheath. In the vascular suture it is especially important to perform sufficient resection of the vascular stumps up to 5 mm. on account of damage to the intima. Interposed microveins are frequently necessary. The vascular stumps are rinsed with heparin before effecting anastomosis. Whenever possible at all, both volar arteries should be sutured, and at least 2 veins per finger. Then follows the suture of both digital volar nerves by the interfascicular technique. The flexor tendon is sutured on the dorsal side, mostly in the form of U-suture. The extremity should be slightly elevated. Drug therapy consists of the administration of dipyridamol, dextrane, heparin; and for infection prophylaxis a mixture of oxacillin-ampicillin. In our first series of 132 replantations, the healing rate was 89%. Cut wounds show the most favorable prognosis, subtotal crush fractures the most unfavorable. All avulsion wounds healed primarily. In cases of skeletization, replantation of the dermal tube is likely to be successful. A good functional result is obtained with the long fingers when preserving the metacarpophalangeal or interphalangeal joints. Distal phalanx replantations are also valuable.