History of replantation: from miracle to microsurgery

[Macroreplantation of the upper extremity: Inventory in 2024]

Macro-amputations are extremely serious traumas and represent one of the rare extreme emergencies in hand and upper limb surgery. Their rarity, especially in our developed countries, makes their treatment relatively unknown by surgical and anesthetic teams. However, the action plan to use during a macro-reimplantation, the decisive elements of pre- and post-operative management, and the key stages of the surgery, must be perfectly known, because they determine the success of a major reimplantation, for the limb survival and the future functional result. After a brief historical overview, the literature review proposed here provides an opportunity for an update on these formidable injuries and propose a treatment algorithm to guide the medical team in the management of these complex patients.

A Biographical Journey Through the History of Ear Reconstruction

This historical literature review of ear reconstruction differs from much of the published literature in that it focuses on the biographies of the innovators and evangelists of ear reconstruction rather than specific techniques. A biographical account of ear reconstruction demonstrates the importance of surgeons as artists, scientists, technicians, politicians, and most importantly carers of this special and fascinating group of patients who benefit from this technically challenging form of reconstruction.

Top five medical innovations in China mainland since Xinhai revolution [1911]: results of AME survey-002

OBJECTIVE

This survey aims to scrutinize important medical innovations in Chinese mainland since Xinhai (Hsin-hai) revolution in 1911, which marked the end of Manchurian imperial rule and the beginning of China's republican era.

METHODS

An online cross-sectional survey was carried out during the period of Dec 29, 2014 to Feb 5, 2015, totaling 37 days. The survey was conducted on the platform provided by DXY (www.dxy.cn), which is the largest medical and paramedical related website in China. An email was sent to all DXY registered users to invite them to participate in a 5-minute survey. The participants were asked to nominate up to four important medical innovations in China mainland since Xinhai revolution. The participant could select 'zero' which means he/she felt there was no important medical innovations, or he/she did not know important medical innovations. It was noted that important medical innovations refer to (I) those with practical and almost immediate significance to improve healthcare; (II) should not only be introducing western technique to China, but those involve major improvement of existing western techniques count; (III) should not be those with important theoretical discovery but did not have almost immediate significance to improve healthcare.

RESULTS

In total 1,513 DXY users participated in the voting. Totally 489 (32.3%), 441 (29.1%), 342 (22.6%), 150 (9.9%), 91 (6.0%) participants provided 0, 1, 2, 3, 4 nominations respectively. (I) Artemisine (Qinghaosu) for malaria treatment (Project 523 team, 1972); (II) arsenic Trioxide (As2O3) for acute promyelocytic leukemia (APL) treatment (ZHANG Ting-Dong and colleagues, 1970s); (III) limb re-plantation (CHEN Zhong-Wei and colleagues, 1963); (IV) all-trans retinoic acid (ATRA) for APL treatment (WANG Zhen-Yi and colleagues, 1988); and (V) Wu's mask for plague prevention (WU Lien-The, 1910), were voted as the top five innovations in China mainland since Xinhai revolution, with 375, 96, 91, 53, and 8 votes respectively.

CONCLUSIONS

In this voting exercise, five achievements were voted as top innovations in China mainland since Xinhai revolution. However, only ATRA for APL treatment was accomplished after the ending of Great Proletarian Cultural Revolution in year 1976 in China.

Hand replantation: A rare case report

We report a case of a hand replantation. A 43-year-old male presented with an amputated right hand. After clinical and radiological examination of the amputated hand and the forearm stump, the patient was consented for hand replantation procedure. Both bones of the forearm were fixed using K-wires. Careful dissection, trimming and repair of the tendons, vessels (two arteries and one vein) and nerves was achieved. The patient tolerated the procedure well and 2 months later showed a progressive improvement in motor and sensory functions. We suggest that a single-vein repair is sufficient for a successful hand replantation.

Upper extremity and digital replantation

Digital replantation has become a well-established technique among reconstructive hand surgeons. Numerous replantation centers around the world have published series with impressive survival rates. The ultimate goal of replantation is the restoration of normal hand or digital function; thus, replantation success is not solely related to the outcome of the microvascular anastomosis, but also to the adequacy of bone, tendon, skin, and nerve repairs. In this manuscript, we review the literature on upper extremity and digital replantation from its historical background to current surgical outcomes, outlining surgical indications and contraindications, and the preoperative, operative, and postoperative management of these patients.

The transplant of the white man's leg: a novel representation of Cosma and Damians miracle

The history of the miracle performed by the patron saints of medicine Cosma and Damian is well known: physicians and historians have dealt with this subject on many occasions, giving rise to a large range of literature. The Author brings up the problem again, on the ground of a novel Spanish painting which has never previously been taken into consideration from a medical point of view but which reserves some surprises and offers a possible psychological consideration of the matter.

Post-operative critical care and outcomes of limb replantation: experience in a developing country

Replantation is the treatment of choice for traumatic amputation. Its success rates vary, reaching 80% in world's best centres. This study analyses management practices of replantation in a regional centre in a developing country. Out of six replantations, four were successful. The median warm ischaemia time of the severed limb was 4.5h (range 1-13.5) and the median duration of general anaesthesia required for initial surgery was 6.25h (range 4.7-8.0). All patients needed intensive care following replantation for a median of 7 days (range 5-15). Pulse oximetry values were observed to be the same in the graft and the patient in successful cases. Two grafts failed. The median haemoglobin values on the 1st, 3rd and 5th post-operative day were 9.8, 7.0 and 8.4g/dl, respectively. The median platelet counts in the same time periods were 118x10(9), 68x10(9) and 205x10(9)L(-1). The median total fluid intake was 2.2, 3.1 and 3.4ml/kg/h on the 1st, 3rd and 5th post-operative day and the median urine output was 2.4, 2.6 and 2.7ml/kg/h, respectively. The observed post-surgical reduction in platelet count normalised by the 5th post-operative day. Higher fluid intake and lower haemoglobin levels appear to minimise the systemic effects of reperfusion injury, preventing the onset of renal failure and promoting graft perfusion. Pulse oximetry was a useful tool to assess graft perfusion and appear to offer a prognostic value. Three of the above 4 patients were traced for review 5 years later and had functioning grafts.