Replantation of forequarter amputation: Report of two cases with successful structural, motor and sensorial results

• Published in: Microsurgery 2021-09, Vol.41 (6), p.562-568
• Main Authors: Özkan, Ömer, Özkan, Özlenen, Uysal, Hilmi, Leblebicioğlu, Gürsel, Tombak, Kadriye, Ogan, Onur, Göztepe, Mehmet Berke
• Format: Article
• Language: English
• Subjects: Amputation; Elbow; Elbow (anatomy); Fixation; Integrity; Ischemia; Mimicry; Muscles; Scapula
• ISSN: 0738-1085; 1098-2752
• DOI: 10.1002/micr.30739

Although there have been numerous reports of major replantation of upper extremity amputations, limited numbers of above‐elbow amputation replantation have been reported. We present the technical details of two successful replantations of forequarter amputations in a nine‐year‐old girl and a three‐year‐old boy. In both cases, the forequarter was amputated due to avulsion traction injuries resulting in amputation including the entire upper limb, while the integrity of the scapula and parascapular muscles was maintained, with no injury to the glenohumeral joint. Replantation was performed, involving a shorter ischemia time with proper fixation, and vascular and neural repairs. Postoperative recovery was uneventful, and motor and sensorial acquisition were quite satisfactory during follow‐up periods of 9 and 6 years, respectively. Proper fixation of the amputated part mimicking the original anatomy, radical debridement of avulsed vessels, and reconstruction of the defect using long vein grafts and neural repair while maintaining proper integrity are the most important factors in success. When the requirements are met, replantation of the forequarter in a child yields a superior outcome, from both the functional and esthetic perspectives. To the best of our knowledge, this is the first report in the English literature involving two sequential cases of such high‐level replantation resulting in successful reacquisition of both viability and function.