|Microsurgery: Transplantation and Replantation by Harry J. Buncke, MD, et al.|
| Tamai18 reported that 76% of his replant patients went on to achieve a "good to excellent" result based on objective functional criteria. Further detailed functional analyses, correlated with a classification of original injuries and operations, can contribute to refinement of patient selection, postoperative monitoring, perioperative pharmacology, physical therapy, and secondary surgery.
Lower extremity replantations generally have lower survival rates and often function poorly even when replantation technically succeeds.21 Hand, forearm, and arm replantations, however, produce acceptable to excellent rates of operative and functional success.18
Toe-to-hand Transfers (Table 38-3)
This subset of free tissue transfers requires successful bone, joint, vessel, tendon, nerve, and soft tissue management to achieve its goal of functional hand reconstruction.
Survival rates are 90% or better in published series.30-32 Re-exploration for vascular compromise occurs in 3.6% 30 to 24% 32 of cases with high rates of salvage.
Secondary procedures were necessary in as many as 83% of one series.31 Strength, appearance, and function appear to make the great toe a superior choice for thumb replacement,30 but donor site complications are significant. Thirty-three percent of one series3l required secondary foot surgery. Continued refinements in donor site management can provide a major decrease in the morbidity of this procedure.
1. Strauch, B., Greenstein, B., Goldstein, R., and Liebling, R.W.: Problems and complications encountered in replantation surgery. Hand Clin. 2:389, 1986.
2. Urbaniak, J.R., and Richards, R.R.: Complications in microvascular surgery. In Complications in Orthopedic Surgery. 2nd Ed. Edited by C.H. Epps. Philadelphia, J.B. Lippincott, 1986.
3. Harrison, S.H.: Fractures of the tibia complicated by skin loss. Br. J. Plast. Surg. 21:262, 1968.
4. Byrd, H.S., Cierny, G., and Tebbetts, J.B.: The management of open tibial fractures with associated soft-tissue loss: External pin fixation with early flap coverage. Plast. Reconstr. Surg. 68:73, 1981.
5. Byrd, H.S., Spicer, T.E., and Ciemy, G.: Management of open tibial fractures. Plast. Reconstr. Surg. 76:719, 1985.
6. Gordon, L., Buncke, H.J., and Alpert, B.S.: Free latissimus dorsi muscle flap with split-thickness skin graft cover: a report of 16 cases. Plast. Reconstr. Surg. 70:173, 1982.
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