Excerpt from: Chapman's Orthopaedic Surgery, 3rd Edition, LWW 2001

Chapt 34 - Replantation, James R. Urbaniak, Division of Orthopaedic Surgery, Department of Surgery, Duke University School of Medicine, Durham, North Carolina 27710.

"No listing of indications or contraindications for replantation is rigid or absolute, and the criteria, although generally similar for most replantation surgeons, vary with individual experience. Future experience with replantation and technological advances in externally powered prostheses are likely to further alter these criteria. On the basis of this standard, good candidates for replantation are those with amputations of the following types:

• Wrist
• Partial hand (through metacarpal level of palm)
• Thumb
• Multiple digits
• Forearm
• Almost any body part of a child
• Elbow and above elbow (only sharply severed or moderately avulsed)
• Individual digit distal to the flexor superficialis insertion

Just as indications for replantation are not absolute, neither are contraindications. Injuries generally not considered ideal for replantation include:

• Amputations in patients with other serious injuries or diseases
• Amputations at multiple or segmental levels
• Severely crushed or avulsed parts
• Amputations in which the vessels demonstrate arteriosclerosis
• Amputations in mentally unstable patients
• Amputations with prolonged warm ischemia time (more than 6 h)
• Individual finger amputations in the adult at a level proximal to the superficialis insertion (proximal interphalangeal joint or proximal)"