FAILURE in limb replantation is often reasonably attributed to factors beyond the surgeon's control. Recently, in the Milwaukee area, a review of two attempts at limb preservation demonstrated that well-known principles of vascular surgery may easily be unwittingly violated in these unusually complex circumstances.
A few milliliters of a weak heparin solution injected through the artery wall was expected to prevent thrombosis in a limb without any circulation.
Perfusing the limb for at least 15 minutes1 to flush existing thrombi out of the vessels was not accomplished.
The restoration of venous circulation2,3 was omitted.
Cooling the tissues to prolong viability while they were without circulation was not done.4
Steps were then taken to insure that circumstances would favor success at the next opportunity for limb reimplantation. A team was formed to include surgeons experienced in vascular and orthopedic procedures. Several bottles of lactated Ringer's solution were stored
WORMAN LW, DARIN JC, KRITTER AE. The Anatomy of a Limb Replantation Failure. Arch Surg. 1965;91(2):211-215. doi:10.1001/archsurg.1965.01320140001001