Major upper extremity amputation is one of the most devastating injuries a patient can face. Unlike lower extremity amputations where prosthetics may restore function, the upper limb remains uniquely challenging. That’s why every effort should be made to replant the amputated extremity. But replantation is only the beginning — secondary reconstructive surgery is often required to optimize function.

In this episode, we review the landmark study on secondary reconstructive surgery after major upper extremity replantation. With a survival rate of 89% in 45 patients, the average number of secondary procedures was three per patient. These procedures varied predictably based on the level of injury:

• Upper arm → Most often required soft-tissue coverage and tendon transfers.

• Proximal forearm/elbow → Free functioning muscle transfers (FFMT) were most common to restore flexion/extension.

• Distal forearm/wrist → Tenolysis dominated, followed by tendon transfers and arthrodesis.

Timing also mattered: soft-tissue coverage occurred early (within weeks), while tenolysis and tendon transfers typically occurred 1–2 years post-replant. The treatment algorithm highlights how zone of injury and level of amputation guide predictable reconstructive needs.

Key Takeaways:

1. Average 3 secondary procedures per successful replant.

2. Procedure type depends on level of amputation.

3. Soft-tissue coverage is early; tendon work often delayed.

4. FFMT is crucial for proximal-level functional restoration.

5. Functional recovery is challenging but achievable with staged strategy.

   
   

📚 References:
Fufa D, Lin CH, Lin YT, Hsu CC, Chuang CC, Lin CH. Secondary Reconstructive Surgery Following Major Upper Extremity Replantation. Plast Reconstr Surg. 2014;134(4):713–720. doi:10.1097/PRS.0000000000000538

🎧 Full episode available now:

Instagram: https://www.instagram.com/plasticsinpractice/  

Spotify: https://open.spotify.com/show/4Ct8jOgYXP9QJin7QOuG3Z?si=JNcBxQmwT2mfz1LSJZEFKA 

Apple: https://podcasts.apple.com/us/podcast/plastics-in-practice-resident-review/id1835564216 

YouTube: https://youtube.com/@plasticsinpractice?si=tqLInp5vvsJFKlRO 

Amazon: https://music.amazon.com/podcasts/8bef056e-7c87-4224-978e-7e691b04554a/ 

📘 Free Study Guides: → https://drive.google.com/drive/u/0/folders/12BUldPbCmihG-ndZh6992WqhRYyxw8ZZ