Mateusz Gładysz FESSH prep

FESSH prep Microsurgery Pooled survival by mechanism of injury, causes of failure, temporary arterial shunting, determinants of functional outcome after arm replantation, secondary procedures

Major (proximal) upper-limb replantation

Last reviewed v1.0

FESSH-076Microsurgery●●● advanced

Regarding replantation after major (proximal) amputation of the upper limb:

  1. 1.In pooled case series, major limb replantation was successful in about two-thirds of cases, more often after sharp than after crush or avulsion amputations.

  2. 2.Most failures of major limb replantation are caused by non-union of the skeletal fixation.

  3. 3.Temporary arterial shunting can reduce warm ischaemia, allowing debridement and skeletal fixation before definitive arterial repair.

  4. 4.After arm replantation, patient age and the timing of nerve repair are the main determinants of functional outcome, whereas amputation level has little effect.

  5. 5.After successful arm replantation, multiple secondary procedures are often required, most commonly nerve repair, functioning muscle transfer and tendon transfer.

FESSH marking: +1 per correct statement, 0 for blank, −1 for incorrect. Click the same TRUE/FALSE button twice to clear it.

Question ID
FESSH-076
First published
Last reviewed
Version
v1.0
Answer key and explanations — open after answering

  1. 1. In pooled case series, major limb replantation was successful in about two-thirds of cases, more often after sharp than after crush or avulsion amputations.

    True

    A 2026 scoping review of 99 publications (1107 patients, 88% upper limb) reported overall replantation success of 68%: 85% after sharp amputation, 45% after crush and 55% after avulsion injuries. The data come from case series and reports, so the figures are approximate.

    • Jaafar Y, Obeida J, Berkane Y, Van Dieren L, Nader E, Gonzalez J, et al.. Major limb replantation: Current status and perspectives. JPRAS Open. 2026;49:96-106. PMID 42077658

  2. 2. Most failures of major limb replantation are caused by non-union of the skeletal fixation.

    False

    The same review attributed most failures to vascular complications, infection and systemic inflammatory response, not to problems of skeletal union. It describes ischaemia–reperfusion injury and surgical complexity as the main constraints on outcome.

    • Jaafar Y, Obeida J, Berkane Y, Van Dieren L, Nader E, Gonzalez J, et al.. Major limb replantation: Current status and perspectives. JPRAS Open. 2026;49:96-106. PMID 42077658

  3. 3. Temporary arterial shunting can reduce warm ischaemia, allowing debridement and skeletal fixation before definitive arterial repair.

    True

    Nunley and colleagues used temporary arterial and venous shunts in eight major limb replantations and revascularisations. Shunting reduced warm ischaemia and allowed identification of vital structures, thorough debridement and rigid fixation before definitive arterial repair, without significant shunt-related complications in that small series.

    • Nunley JA, Koman LA, Urbaniak JR. Arterial shunting as an adjunct to major limb revascularization. Ann Surg. 1981;193(3):271-3. PMID 7212788

  4. 4. After arm replantation, patient age and the timing of nerve repair are the main determinants of functional outcome, whereas amputation level has little effect.

    False

    Wang's systematic review of 79 arm replantations found that amputation level and type of injury significantly influenced the final outcome, whereas patient age and timing of nerve repair did not. Amputations through the distal third of the arm, and sharp rather than crush or avulsion injuries, did better.

    • Wang C, Askari M, Zhang F, Lineaweaver WC. Long-Term Outcomes of Arm Replantation. Ann Plast Surg. 2020;84(3S Suppl 2):S151-S157. PMID 32028338

  5. 5. After successful arm replantation, multiple secondary procedures are often required, most commonly nerve repair, functioning muscle transfer and tendon transfer.

    True

    Wang's review recorded 111 secondary procedures, an average of 2.6 per patient; of these procedures, nerve repair (23%), functioning muscle transfer (20%) and tendon transfer (17%) were the commonest. Satisfactory (Chen I–II) function was achieved in about half of patients (49%).

    • Wang C, Askari M, Zhang F, Lineaweaver WC. Long-Term Outcomes of Arm Replantation. Ann Plast Surg. 2020;84(3S Suppl 2):S151-S157. PMID 32028338