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出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2015/08/13 06:43:07」(JST)

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Replantation has been defined by the American Society for Surgery of the Hand as "the surgical reattachment of a body part, most commonly a finger, hand or arm, that has been completely cut from a person's body".^[1]

Replantation of amputated parts has been performed on fingers, hands, forearms, arms, toes, feet, legs, ears, avulsed scalp injuries, a face, lips, penis and a tongue.

The repair of the nerves and vessels (artery & vein) of the amputated part is essential for survival and function of the replanted part of the body. Using an operating microscope for replantatation is termed microvascular replantation. However, vessels and nerves of large amputated parts (e.g. arm and forearm) may be reconnected using loupe or no magnification.

History

The first replantation to be performed in the world involved repair of the brachial artery and was done by a team of chief residents led by Dr. Ronald Malt at Massachusetts General Hospital in Boston, MA, USA in 1962. The arm of a 12-year-old child severed at the level of the proximal humerus was reattached.

The first report of a replantation using "modest magnification and keen vision" was reported by a team led by Zhong-Wei Chen of the Sixth People's Hospital in Shanghai in 1963 writing in the Chinese Medical Journal. A machinist's hand was reattached at the level of the distal forearm. In this case vascular couplers were used for the vessels as the Chinese did not have good micro sutures available at that time. As there was little communication between China and the Western World in those years, Ronald Malt and Charles McKhann published in JAMA in 1964 their first two replantations without referencing the earlier published article from China.

First revascularization of a partially amputated finger: Kleinert (1963) First digital replantation: Komatsu & Tamai, Japan (1965)

The Procedure

Replantation requires microsurgery and must be performed within several hours of the part's amputation at a center with specialized equipment, surgeons and supporting staff. To improve the chances of a successful replantation, it is necessary to preserve the amputate as soon as possible in a cool (close to freezing, but not at or below freezing) and sterile or clean environment. Parts should be wrapped with moistened gauze and placed inside a clean or sterile bag floating in ice water. Dry ice should not be used as it can result in freezing of the tissue. There are so called sterile "Amputate-Bags" available which help to perform a dry, cool and sterile preservation.

Parts without muscles such as fingers can be preserved for many hours, while major muscle containing parts such as arms need to be re-attached and revascularized within 6–8 hours to have a viable limb.

Outcome of major limb replantations can be predicted by the potassium level of the blood which flows out of the replanted part after revascularization as a high level of potassium can be a marker of muscle and tissue death.

It is important to also collect and to preserve those amputates which do not look like being "replantable". A microsurgeon needs all available parts of human tissue to cover the wound at the stump and thus to prevent further shortening of the stump. In some cases (e.g. forearm) the task of an important joint (e.g. elbow) can be conserved for improved prosthetic success.

Severe crush injuries, multilevel injuries, avulsion injuries, and in some cases jagged tearing of tissue, can preclude replantation and salvage, requiring revision amputation of the stump.

References

^ http://www.assh.org/Public/HandConditions/Pages/Replantation.aspx

External links

eMedicine: Replantation

UpToDate Contents

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1. 成人患者における重度の四肢外傷 severe extremity injury in the adult patient
2. 重度の四肢外傷の外科的マネージメント surgical management of severe extremity injury
3. 腹部大動脈瘤の開腹手術による修復 open surgical repair of abdominal aortic aneurysm
4. 成人外傷患者における脾損傷のマネージメント management of splenic injury in the adult trauma patient
5. 成人外傷患者における脾臓損傷の外科的マネージメント surgical management of splenic injury in the adult trauma patient

English Journal

Periapical tissue reactions to calcium hydroxide and MTA after external root resorption as a sequela of delayed tooth replantation.

Marão HF, Panzarini SR, Aranega AM, Sonoda CK, Poi WR, Esteves JC, Silva PI.SourceDivision of Oral and Maxillofacial Surgery, School of Dentistry of Araçatuba, UNESP, São Paulo State University, Araçatuba, SP Department of Surgery and Integrated Clinics, School of Dentistry of Araçatuba, UNESP, São Paulo State University, Araçatuba, SP Department of Periodontology, School of Dentistry of Araraquara, UNESP, São Paulo State University, Araraquara, SP, Brazil.
Dental traumatology : official publication of International Association for Dental Traumatology.Dent Traumatol.2012 Aug;28(4):306-13. doi: 10.1111/j.1600-9657.2011.01090.x. Epub 2011 Dec 8.
Abstract - Clinical experience has shown that most avulsed teeth are replanted after a long extra-alveolar time and dry or inadequate wet storage, causing necrosis of periodontal ligament cells. This condition invariably leads to development of external root resorption, leaving the filling mate
PMID 22151580

The effect of splint material and thickness on tooth mobility after extraction and replantation using a human cadaveric model.

Kwan SC, Johnson JD, Cohenca N.SourceDepartments of Endodontics Pediatric Dentistry, University of Washington, Seattle, WA, USA.
Dental traumatology : official publication of International Association for Dental Traumatology.Dent Traumatol.2012 Aug;28(4):277-81. doi: 10.1111/j.1600-9657.2011.01086.x. Epub 2011 Nov 23.
Abstract - Although current guidelines for the treatment of traumatic injuries recommend the use of 'flexible' splints, the precise definition of what is considered flexible versus rigid has not been rigorously defined, leaving the clinician with a wide range of options for this critical factor
PMID 22107132

Japanese Journal

切断指再接着術の周術期管理 (特集形成外科における手術スケジュール : エキスパートの周術期管理)

神田俊浩
Pepars (83), 36-45, 2013-11
NAID 40019892199

肩腱板断裂の夜間牽引に関する術前オリエンテーションDVDの作成と評価

執印沙枝子,鈴木ゆかり,長尾章弘 [他]
信州大学医学部附属病院看護研究集録 41(1), 99-101, 2013-03
NAID 40019874894

肩腱板断裂の夜間牽引に関する術前オリエンテーションDVDの作成と評価

執印沙枝子,鈴木ゆかり,長尾章弘,赤池勝美,植村一貴
信州大学医学部附属病院看護研究集録 41(1), 99-101, 2013-03
肩腱板断裂術施行後に行われる夜間牽引についての術前オリエンテーションDVDを作成した。そのDVDを患者に視聴してもらい，牽引についてイメージができたか，また，牽引時の注意点等が理解できたかについてアンケート調査を行いDVDの評価を行った。DVDは，多少の改善点があったものの，治療のイメージができ理解が得られる内容であったと評価できた。
NAID 120005351980