Long-Term Results after Macroreplantation of the Upper and Lower Extremity

Between 1981 and 2000, 85 amputation injuries of the upper extremity and 18 of the lower extremity were treated. There were 20 at the upper arm proximal, 40 middle forearms, 23 distal forearms and wrist level, and 2 multiple level amputations. The overall survival rate in the series was 92%. In 5 of 85 cases, early secondary amputation because of vascular failure was necessary. Half of the patients had a follow-up of more than 2 years and could be reviewed and evaluated according to Chen's classification. Putting grades I and III results together, a functional extremity could be reconstructed at the upper arm level in 25% of cases, in the proximal forearm in 30%, and in the distal forearm in 58% of cases.

The main advantage of replantation/revascularisation in the upper limb is the possibility of restoring some sensibility to the hand, in addition to partial motor recovery that always exceeded more than two individual motor functions offered by any type of prosthesis currently available. The higher cost and number of operations needed, and longer duration of disability, are justified by a significant increase in life quality.