The Reconstructive And Orthopedic Surgery
The rapid development of industry in the 20th century dramatically increased the number of serious injuries, the result of which is a complete abruption of the limbs. Dr. Malt performed the first successful replantation (return of the separated segment to life in the same place of the human body) in 1962 in Boston (USA). Later on the operations of replantation started to be performed in many clinics abroad and in our country.
Most often fingers are separated accidentaly. They are the most frequent subject of replantation. Among the main causes of injuries that cause the limbs separation are non-compliance to safety rules when working with circular saws, various cutting machines and guillotines. Sever separation occurs when tightening the limb, often together with clothes, gloves into any spinning gear, then the segment is detached.
The replantation of limbs was made possible due to the development of microsurgery. There are macroreplantation (replantation of limbs after amputation above the wrist or ankle) and microreplantation (after amputation below these joints as well as the scalp, ears and penis). The technique of macroamputation is well designed, but the short-term muscle tolerance to ischemia leads to severe post-ischemic disturbances in the limbs, as well as to the general complications (liver toxicity and kidney).Thus, the higher the amputation is carried out, the more problematic is the function restoration.
Indications for replantation is amputation without expressed crushing of tissue. Urgent indications arise in the amputation of a thumb, forearm or the entire arm. In children, even partial amputation of a finger could serve as a sign to make replantation.There are complications of surgery such as arterial and venous thrombosis occurring that require reoperation. After operations, careful active and passive movements are possible only on the 6th or the 8th day after the operation.