Macroreplantations of the upper extremity : Surgical technique and research progress

Introduction: Since the first macroreplantation of upper limb, conducted in 1962 by Ronald Malt in Boston, the surgical technique has refined. For pioneers in microsurgery, tissue survival with functional failure was acceptable. Today, functional recovery after replantation has become the ultimate goal. This article presents our university experience about macroreplantation. Material and Methods: Since the 1980s, two series of patients with amputation proximal to the wrist were replanted in our university. The surgical technique is presented step by step. Results: The functional and subjective results are discussed. Particular attention is given to the pre-surgical phasis of replantation and management of the patient’s arrival. We discuss the technical steps of macroreplantation and the need for clear guidelines. We review the progress of research to minimize ischemic time and reduce the risk of ischemia-reperfusion.Conclusion: With the refinement of the surgical technique, the functional results could be greatly improved. However due to the rarity of the macroreplantations, it must be assessed and treated by specialized teams.