Hand and upper extremity amputations are devastating injuries — but modern microsurgery has transformed outcomes. Not every part should be replanted, and today’s decisions balance survival, function, and efficiency.
In this episode of Plastics in Practice, we dive into the current concepts of upper extremity replantation. Since the first successful thumb replantations in the 1960s, the field has shifted from “save every part” toward careful patient and injury selection, maximizing functional recovery, and minimizing unnecessary costs and transfers.
We discuss:
Clear Indications: thumb, multiple digits, mid-palm amputations, all pediatric cases.
Contraindications: severe crush, multilevel injuries, prolonged normothermic ischemia, or patients unable to rehab.
Injury Mechanism: sharp injuries have highest survival (~91%), while crush and avulsion lag behind but show improving outcomes with vein grafts.
Distal Tip Injuries: often viable candidates — vein/nerve repair may not always be necessary.
Ischemia Tolerance: digits can survive much longer than previously thought, with reports of >90 hours cold ischemia.
Special Populations: children have remarkable recovery, and age alone shouldn’t be an exclusion.
Finally, we cover evolving practices such as replantation regionalization, use of telemedicine for triage, and pearls for venous drainage strategies.
References:
Prucz RB, Friedrich JB. Upper Extremity Replantation: Current Concepts. Plast Reconstr Surg. 2014;133(2):333-342. doi:10.1097/01.prs.0000437254.93574.a8
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