Replantation Surgery and Microsurgical Technique

The development of surgery using high magnification has allowed reconstructive surgeons to operate on the small blood vessels of the distal extremity which previously were beyond technical limits. Using this new technology reconstructive surgeons are able to replant amputated upper extremities with a high degree of survival and functional success. The world's first successful clinical replantation was performed by Malt and McKhann1 in 1962. They replaced the arm of a 12 year old boy who had been amputated at the mid-humeral level. In 1965, Komatsu and Tamai2 used the surgical microscope to replant a thumb amputated at the metacarpophalangeal level. This first successful microsurgical replantation was preceded by considerable ex perimental work. Jacobson and Suarez3 using an operating microscope reported a 100 percent patency rate in arteries 1.4 mm in diameter. Harry Buncke, a plastic surgeon continued development of the microsurgical technique, instruments, and sutures, that would result in successful replantation surgery. In 19634 Buncke successfully replanted a rabbit ear anastomosing an artery less than 1 mm. Next he replanted monkey digits5 and even performed a toe to hand transfer with primary arterial and venous anas tomoses.