Secondary procedures in replantation.

The success of replantation surgery is not judged by survival of the replanted part, but by the functional outcome attained. Hence, primary repair of all injured structures is the preferred aim. At times, constraints induced by the ischemia time and nature of injury preclude primary repair. In such situations, secondary procedures are inevitable. Secondary procedures are also frequently required to improve the function and appearance of the replanted extremity. The incidence of secondary procedures will vary with the level of replantation and the type of patient population. Secondary procedures are difficult because they carry risk of injury to the vital neurovascular structures that now lay at nonanatomical locations. Nevertheless, when indicated and performed with caution they could significantly raise the functional status of the individuals.