• Archives of Reconstructive Microsurgery
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• v.2 no.1
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• pp.53-61
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• 1993

High level, major limb amputation above the wrist and ankle joint has some characteristic problems because of the large muscle mass and poor potential for nerve regeneration. As an adjunct method to reduce warm ischemic time prior to bony stabilization, temporary vascular shunting by simple catheterization has been performed, which has not been associated with any significant complication and has improved on success rate in replantation surgery. The authors have experienced 198 cases replantation of amputated limbs and digits from September, 1983 at the Korea medical center, Guro hospital, of which, 13 cases of successful replantation of amputated limbs by avulsion injury above the wrist and ankle joint level, which is generally considered as contraindication, were followed up for average 4.5 years(minimum 1.5 to maximum 8.4 years) on terms of survival rate, function and appearance. The clinical analysis upon these cases is to be presented with review of references.

• Proceedings of the KIEE Conference
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• 2006.04a
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• pp.42-44
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• 2006

Up to the present, finger replantation patients have complained about various symptoms because of blood circulatory failure. Objective evaluation methods for the level of the blood circulatory failures in fingers were needed other than patient's subjective symptoms and complaints. Photoplethysmogram(PPG) measured from fingers is very useful for evaluation of vascular aging and sclerosis level since the PPG signal represents characteristics of peripheral vascular. Several researchers have reported that second derivative of the finger PPG waveform was useful to evaluate vascular compliance and developed various analysis methods for vascular compliance. However, vascular compliance study for finger replantation patient was never evaluated by using second derivative of PPG. Therefore, we aimed to objectively compare and to assess normal and replanted finger vascular compliance using the second derivative of PPG waveform in this study. The evaluated factors of second derivative of PPG are 'a', 'b', 'c', 'd', 'e' and b/a represents vascular compliance. Study found out that when vascular compliance is decreased, b/a is increased, the absolute value of b/a is decreased. For 43 finger replantation patients, the average vascular compliance of replanted finger is lower than the normal finger statistically(p=0.001). we suggested an objective evaluation of finger vascular compliance for finger replantation patients and effect of surgical operation.

• Archives of Plastic Surgery
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• v.39 no.4
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• pp.404-410
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• 2012

Background First suggested by Brent in 1979, the pocket principle is an alternative method for patients for whom a microsurgical replantation is not feasible. We report the successful results of a modified palmar pocket method in adults. Methods Between 2004 and 2008, we treated 10 patients by nonmicrosurgical replantation using palmar pocketing. All patients were adults who sustained a complete fingertip amputation from the tip to lunula in a digits. In all of these patients, the amputation occurred due to a crush or avulsion-type injury, and a microsurgical replantation was not feasible. We used the palmar pocketing method following a composite graft in these patients and prepared the pocket in the subcutaneous layer of the ipsilateral palm. Results Of a total of 10 cases, nine had complete survival of the replantation and one had 20% partial necrosis. All of the cases were managed to conserve the fingernails, which led to acceptable cosmetic results. Conclusions A composite graft and palmar pocketing in adult cases of fingertip injury constitute a simple, reliable operation for digital amputation extending from the tip to the lunula. These methods had satisfactory results.

• Archives of Reconstructive Microsurgery
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• v.21 no.2
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• pp.106-110
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• 2012

We present the case of a 49-year-old man with a dog bite on his right index finger at the mid-phalanx level. The finger was severely contaminated by the dog bite but, the amputation margin was clean. We replantated the stump. His finger was recovered very successfully 12 months later. It is recommended that in these types of cases, replantation of the severed finger should proceed even if the amputated finger was contaminated by the dog bite, unless there are other factors that prevent replantation.

• Archives of Reconstructive Microsurgery
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• v.9 no.2
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• pp.186-189
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• 2000

A case of distal lower leg replantation, in an elderly patient, was successfully performed after retrieval of the amputated limb from 3 hours of immersion in seawater. Due to the patient's age, bony union was delayed and functional nerve recovery was unsatisfactory. After massive saline irrigation of the amputated part, employing a catheter through the main artery, as well as, prophylactic antibiotics to prevent infection by Aeromonas, there were no postoperative complications. Despite the issue of age, immersion of an amputated part into seawater is not a contraindication of replantation.

• Archives of Reconstructive Microsurgery
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• v.12 no.2
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• pp.105-111
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• 2003

It has been known that the vessels of the finger tip are very small and have many branches, so the anastomosis of this vessel is very difficult. But when this operation achieves success, the replanted finger tip provides adequate soft tissue, restoration of the length, sensory and nail. The authors describe the result of finger tip replantation in 94 patients, 103 finger tips, from October 1999 to June 2002. We performed the salvage procedure in all cases. The success rate of finger tip replantation was 74.8%. We achieved higher success rate, when we succeeded anastomosis of the central artery. The function of the replanted fingers was good. The average TAM was 80% and patient satisfaction was high. We be live that we can achieve higher success rate by anastomosing central artery and performing delicate salvage procedure.

• The Journal of the Korean dental association
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• v.11 no.4
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• pp.287-291
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• 1973

A case report of replantation of extracted teeth. A 11-year-old female child patient whose right and left 1st premolars were dislocated by accident, which was treated by means of tooth replantation and obtained the following results. 1) In childhood whose development and growth were prominent prognosis were excellent. 2) The better results were drew by tooth fixation with acrylic resin after ligature the teeth with wire. 3) To treat the tooth replantation combination with canal treatment brings on the good results. 4) We can maintain the natural teeth, which could get the same function as before. According to previous results, the technique can be usd clinically.

• Archives of Plastic Surgery
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• v.47 no.2
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• pp.182-186
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• 2020

We report our experience of treating two patients with ankle amputation with different presentations. The first case was a clean-cut sharp amputation. The second case was an avulsion injury following a motor vehicle accident in a patient who arrived 8 hours after the injury. Replantation was successful in both cases. In avulsion injuries, a secondary operation for wound coverage is required at a later stage. With good strategy and a support team, encouraging limb survival outcomes are possible post-replantation.

• Archives of Plastic Surgery
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• v.38 no.5
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• pp.642-648
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• 2011

Purpose: The recent advances in microsurgical techniques and their refinement over the past decade have greatly expanded the indications for digital replantations and have enabled us to salvage severed fingers more often. Many studies have reported greater than 80% viability rates in replantation surgery with functional results. However, replantation of multi-level amputations still remain a challenging problem and the decision of whether or not to replant an amputated part is difficult even for an experienced reconstructive surgeon because the ultimate functional result is unpredictable. Methods: Between January of 2002 and May of 2008, we treated 10 multi-level amputated digits of 7 patients. After brachial plexus block, meticulous replantation procedure was performed under microscopic magnification. Postoperatively, hand elevation, heat lamp, drug therapy and hyperbaric oxygen therapy were applied with careful observation of digital circulation. Early rehabilitation protocol was performed for functional improvement. Results: Among the 19 amputated segments of 10 digits, 16 segments survived completely without any complications. Overall survival rate was 84%. Complete necrosis of one finger tip segment and partial necrosis of two distal amputated segments developed and subsequent surgical interventions such as groin flap, local advancement flap and skin graft were performed. The overall result was functionally and aesthetically satisfactory. Conclusion: We experienced successful replantations of multi-level amputated digits. When we encounter a multi-level amputation, the key question is whether or not it is a contraindication to replantation. Despite the demand for skillful microsurgical technique and longer operative time, the authors' results prove it is worth attempting replantations in multi-level amputation because of the superiority in aesthetic and functional results.

• Archives of Craniofacial Surgery
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• v.19 no.4
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• pp.304-308
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• 2018

Replantation using microvascular anastomosis is considered to be the optimal method in treating the amputated ear in terms of resulting color, texture, and shape. Only a few cases of ear replantation have been reported because it is anatomically difficult to identify suitable vessels for anastomosis. We successfully replanted the amputated helical rim of the ear using single arterial anastomosis. A 37-year-old man had his helical rim amputated by a human bite. The amputee was about $4{\times}1cm$ in dimension, composed of skin and soft tissue including auricular cartilage. Replantation was performed anastomosing a small artery of the amputee with a terminal branch of the posterior auricular artery. After replantation, intravenous heparinization was performed and prostaglandin E1 and aspirin were administered. Venous congestion was decompressed by stab incisions applied with heparin solution soaked gauze. Venous congestion of the amputee slowly began to resolve at 4 days after the operation. The amputated segment of the helical rim survived completely with good aesthetic shape and color. The authors propose that performing microvascular anastomosis should be attempted especially if it is possible to detect vessels on cut surfaces of ear amputee and stump. Proper postoperative care for venous congestion, arterial insufficiency, and infection should be followed for amputee survival.