An exceptional surgical procedure: double reimplantation

Reimplantation of a double limb amputation is an extremely delicate procedure that has never been performed in our country.

Dr. David, a plastic and hand surgeon who performed the procedure* in Nice, explains the principles of such an operation.

* With the help of Dr Rémi Foissac, Dr Olivier Camuzard and Pr Dumontier.

Understanding reimplantation or "graft" surgery in three points.

What factors determine the success of this extremely rare procedure?

- Rapid emergency treatment and positioning of the amputated limb in the cold, but not in contact with ice.

- Good medical resuscitation to counter revascularization syndrome.

- Perfect mastery of microsurgical techniques.

- Perfect knowledge of the anatomy and surgical constraints of this procedure.

What are the surgical principles of limb or face "graft" reimplantation?

- As a first step, the surgeon trims any tissue that appears non-viable.

- The next step is to re-establish a solid bony base by performing a solid osteosynthesis.

- Re-establish arterial continuity using a microscope, so that the amputated limb is perfused again.

- Reconnect the veins to allow blood to flow back into the veins.

- Suture all the nerves microsurgically so that the reimplanted part is functional again.

- Restore continuity to muscles and tendons while performing a preventive fasciotomy.

- Finally, suture the skin.

When should a limb, finger, ear or other part of the face be re-implanted?

We must always fight to save what can be saved, even if the function is diminished. As plastic surgeons, we know that aesthetics is already function.

You need to wait about three weeks to be sure that the re-implantation has worked. There is a risk of vessel stenosis or infection of poorly vascularized tissue.

The functional prognosis of the reimplanted limb depends not only on the quality of the nerve repair, but also on the type of trauma. In the case of trauma to the arm, it takes an average of two years before results can be assessed.

In the medium term, cosmetic and reconstructive surgery can improve both the functional and aesthetic appearance of the re-implanted part.