Major limb replantation: a Thai experience.

From May 1986 to December 1992, we performed 36 major limb replantations in 35 patients; 30 were complete and 6 were incomplete amputations. Twenty-eight of these patients were male. Their ages ranged from 5 to 81 years, the average being 22 years. The levels of injury were 13 hemihand, 8 wrist, 5 lower forearm, 5 upper forearm, and 5 above the elbow amputation. The degrees of injury were 8 guillotine, 14 local crush, 9 diffuse crush, and 5 avulsion amputation. There were a partial loss of digits in 4 hemihand amputations and one failure in an above-elbow amputation--a limb survival rate of 95%. The functional result was evaluated in 30 patients, one with bilateral hemihand. Most patients regained useful hand function, with 20 achieving a grade I functional result--an ability to resume original work--or grade II functional result--an ability to do some gainful work--according to Chen's criteria. The best functional results were obtained in injuries which were near the wrist joint.