Multidisciplinary approach in upper extremity replantation: a case report

Work-related traumatic upper arm amputations still represent a significant issue, with prevalence estimates of 11.6/100,000 in Europe. These injuries significantly affect patients' quality of life by causing loss of function with reduced autonomy, social and emotional consequences. We present the case of a 24-year-old man who suffered from a complete amputation of his left forearm due to a workplace accident involving a cast iron press. After clinical stabilization, a multidisciplinary team composed of plastic, orthopedic, and vascular surgeons performed a preoperative evaluation and subsequent successful replantation surgery. In our case, despite the mechanism of amputation, a prompt multidisciplinary evaluation, the minimal ischemia time, the bone-sparing reduction and fixation, muscle debridement, and doppler ultrasound assessment of the reimplanted limb skin flap vascularization achieved an optimal long term functional outcome further enhanced by postoperative rehabilitation, guided by an individualized program. Two years post-replantation, the patient regained sensitivity on all fingers with complete hand and forearm intrinsic muscle activity, enabling a return to work within one year. While upper limb replantation poses significant challenges, our case underscores the potential for favorable outcomes with multidisciplinary collaboration and postoperative comprehensive rehabilitation strategies.