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Concept
Replantation
Résumé
Replantation or reattachment has been defined by the American Academy of Orthopaedic Surgeons as "the surgical reattachment of a body part (such as a finger, hand, or toe) that has been completely cut from the body".
Examples would be reattachment of a partially or fully amputated finger, or reattachment of a kidney that had had an avulsion-type injury.
Replantation of amputated parts has been performed on fingers, hands, forearms, arms, toes, feet, legs, ears, scalp, face, lips, penis and a tongue. It can be performed on almost any body part of children.
Replantation is performed in response to traumatic amputation. Sharp, guillotine-type injuries with relatively uninjured surrounding tissue have the best post-replantation prognosis, with a success rate of 77%.
Severe crush injuries, multi-level injuries, and avulsion injuries often mangle soft tissue to the point of precluding rejoining of essential blood vessels, making replantation impossible. In such cases, revision amputation of the stump may be necessary.
Replantation requires microsurgery and must be performed within several hours of the part's amputation, at a center with specialized equipment, surgeons and supporting staff. To improve the chances of a successful replantation, it is necessary to preserve the amputate as soon as possible in a cool (close to freezing, but not at or below freezing) and sterile or clean environment. Parts should be wrapped with moistened gauze and placed inside a clean or sterile bag floating in ice water. Dry ice should not be used as it can result in freezing of the tissue. There are so called sterile "Amputate-Bags" available which help to perform a dry, cool and sterile preservation.
Parts without major muscle groups, such as the fingers, have been replanted up to 94 hours later, although 12 hours is typically the maximum ischemic time tolerated. Parts that contain major muscle groups, such as the arms, need to be replanted within 6–8 hours to have a viable limb.
Source officielle
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