Replantation of multi-level hand severances.

Since 1990, the replantation of hands severed at multiple levels has been carried out successfully for 22 patients. In each case the motor and sensory functions of the hand were recovered satisfactorily. We suggest that such wounds should be named 'multi-level severances' and should be classified into five groups according to the wound localities. In order to shorten ischaemic time, debridement should be carried out simultaneously by several groups. The main technical points of the operation are: (1) The order of replantation for multiply severed fingers is that the most distant section should be reattached first, and then the more proximal part. (2) High quality blood vessel anastomosis must be ensured. (3) Avoid taking the blood vessels, nerves and tendons from severed region. (4) During the operation, care should be taken to ensure that the replanted fingers' segments are protected from collision and stretching. In the early stages following the operation correct functional exercise is very important.