Advances in Limb Preservation: From Replantation to Transplantation

Over the course of the last 60 years, microsurgical techniques, instrumentation, operating microscopes, and suture materials have all been perfected. Microsurgery training became part of the standard curriculum in plastic, orthopedic, and hand surgery programs. Despite those advances, limb replantation and transplantation are still surgical emergencies owing to limits in composite tissue viability under ischemia. Amputated parts, particularly containing large volumes of muscle, have to be revascularized within 4 hours in order to prevent permanent tissue damage. Static cold storage is the current standard to prolong ischemia time with limited success. Our research for the last 7 years has focused on extending ischemia time prior to revascularization. Our long-term goal is to make replantation and transplantation procedures elective. The following essay is the summary of our efforts.