Waikakul et al identified factors associated with outcome following reattachment of an amputated involving the upper limb. This can help identify patients who may have a high risk of poor outcome following the procedure. The authors are from Mahidol University in Bangkok, Thailand.


Patients excluded from reimplantation:

(1) multiple injuries (to other sites than limb)

(2) prolonged warm ischemia time ( > 12 hours)

(3) multi-level amputation with severe crush injuries (mangling)

(4) severe contamination of the amputated part

(5) serious comorbid condition

(6) no-reflow phenomenon on re-anastomosis


Factors associated with a poor outcome:

(1) heavy cigarette smoking

(2) extended crush injury (vs local crush or avulsion)

(3) amputation of the upper arm (vs elbow or below)

(4) poor preservation of the amputated segment (this was a better predictor than the ischemia time)

(5) failure of skeletal muscle to contract after electrical stimulation


The main vessels were connected by heparinized silastic tubing while connection of the bones were performed. A high venous potassium (> 6.5 mmol/L) from the amputated segment at 30 minutes after re-perfusion was associated with a high rate of failure.


Extended crush injuries had the worst outcome. Local crush injuries were usually associated with good outcomes. The outcome after avulsion injury was affected by the extent of damage to tendons and nerves.


Severe environmental contamination was associated with extended crush injury and with increased risk of infection with reimplantation failure.


Fasciotomy was performed on patients to reduce the chance of a compartment syndrome.


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