Successful replantation of an amputated nasal tip by microvascular anastomosis

Successful microsurgical replantation of a completely avulsed nasal tip is presented. The result is excellent. The technical challenge involved no sizable veins for drainage. This problem was solved by an artery-to-vein shunting. For facial avulsions, there is nothing superior to the original tissue, and replantation should always be attempted first.     

Completely successful replantation of an amputated ear by microvascular anastomosis

A completely successful microvascular replantation of an avulsed ear using the superficial temporal bundle is presented, and the advantages of this procedure are discussed.     

Microsurgical replantation of the amputated nose

A case of successful replantation of the nose is presented. Two arteries and one vein were anastomosed, providing a stable framework for direct revascularization of the amputated nasal segment. This resulted in complete survival of the nose, with an excellent aesthetic result. However, despite successful microsurgical arterial and venous repair, significant postoperative blood loss still occurred as a result of anticoagulation. In cases of the amputation of specialized structures, the improved functional and cosmetic result obtained with replantation must be weighed against the risk of blood-borne disease transmission when postoperative transfusion is required. Recognizing the potential need for postoperative transfusion in these cases is important in allowing the surgeon to exercise appropriate judgment in deciding whether replantation should be performed.     

Successful replantation of lower leg and foot, with good sensibility and function.

The successful replantation of the lower part of a leg with the foot is reported in a 17-year-old boy. Adequate protective sensibility was obtained, and he walks well with a 3-inch lift on that shoe. He is also able to hike, climb, swim, dive, and engage in most normal activities. The pros and cons of leg replantation are considered.     

Bilateral high upper limb replantation in a child

Bilateral high amputation of upper limbs in a child is a very unusual injury. In the present case, although the amputation was high and significant avulsion was present, the age of the child (6 years) made the case both challenging and encouraging--challenging because of the anticipated systemic effects of reperfusion, and encouraging because the long-term prognosis is always more encouraging in a child.     

Successful replantation in the face of absent venous drainage: an experimental study

Inadequate venous outflow is the factor most responsible in digital replantation failure and is a common cause of tissue loss in general. An experimental replantation model utilizing the rabbit ear was used to study the extreme example of venous congestion: absent venous drainage in the replanted part. Results of this study support the use of single arterial inflow along with an efferent AV fistula for outflow in the management of replants with absent venous drainage. Potential indications for the use of an efferent arteriovenous fistula in digital revascularization include the following: (1) the finding of distal veins too small to reanastomose, as is often the case in children and at distal levels in adults; (2) preferential destruction of distal venous structures, as commonly seen in degloving or other dorsal injuries; and (3) in the management of postreplant venous thrombosis.     

Successful treatment of meningeal involvement in Hodgkin's disease in a child

Meningeal involvement was diagnosed in a child with IVB degree Hodgkin's disease following three alternatives cures with MVPP/B-DOPA. Irradiation of the skull with alternative intrathecal injections of drugs were applied. The treatment was completed 16 months after the diagnosis of meningeal involvement. No symptoms are observed.     

Crossover replantation and fillet flap coverage of the stump after ectopic implantation: a case of bilateral leg amputation

A successful case of crossover replantation of the left foot to the stump of the right leg and temporary ectopic implantation of the right amputated foot on the forearm is described. The ectopically implanted right foot was used as a free fillet flap for the late reconstruction of the left leg stump. At the latest follow-up examination, 18 months after the accident, the patient was able to walk independently with a prosthesis on the stump of the left leg. Both the cross-replanted foot and the free filleted foot flap, used for the reconstruction of the left leg stump, have maintained adequate protective sensation. The importance of utilization of amputated parts for functional reconstruction is stressed. Crossover replantations and ectopic implantations should be considered in bilateral amputations for the salvage of at least one extremity.     

Repair of a lower leg defect with an ipsilateral gracilis myocutaneous flap.

We report the use of a gracilis myocutaneous flap from the same thigh to repair a defect of the lower leg. This could be a useful alternative in well selected cases.