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Replantation of all but the most proximal amputations requires microsurgery. Although many surgeons have been trained in microsurgical techniques, successful treatment and management of trauma patients receiving replantation surgery also require the considerable resources of an emergency replantation center: teams of skilled, trained personnel and extensive surgical and postoperative care resources available 24 hours a day, 365 days a year. To ensure the success of replantation surgery, the following elements should be at hand:
1. An efficient ground and air transportation system to transfer the patient from the injury site or referring hospital to the replant center;
2. Experienced surgical teams, working in 4- to 6-hour relays;
3. A well-prepared emergency room staff to stabilize and quickly evaluate the patient with physical examination, x rays, and laboratory tests;
4. Experienced anesthetists, operating room, and microsurgical staffs available 24 hours a day;
5. Proper microscopes, instruments, and sutures;1
6. A carefully trained nursing staff for postoperative care and monitoring;
7. Physical and occupational therapists trained in postreplantation rehabilitation;
8. Psychologists and social workers to help the patient cope with his or her injuries and continue an active and useful life.
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When a patient arrives at the replant center with an amputation or partial amputation,2 the surgeon must decide whether the patient will be best served by replantation or amputation. The latter must always be considered for a patient with multiple injuries, for whom a prolonged replant procedure would be life-threatening. The age, functional requirements, and general condition of the patient must be evaluated. The question of replantation or amputation must also be weighed against the uncertainties of ultimate function, psychologic well-being, and the cost of treatment. The goal of replantation surgery is successful restoration of function, not just successful revascularization.3-5
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