Microsurgical replantation and revascularization following the accidental amputation of an upper extremity

At the request of the director of CHUM’s centre of expertise in microsurgical replantation and revascularization, the Institut national d’excellence en santé et en services sociaux (INESSS) carried out a literature review concerning the necessary volumes for the granting and maintaining of practice privileges in microsurgical replantation and revascularization. Following the literature review, INESSS has notably concluded that:

• Nearly all the publications on microsurgical replantation and revascularization that were consulted mention the importance of having cases of traumatic amputation of an upper extremity managed by an experienced, qualified surgeon.
• The indications and contraindications for microsurgical replantation of upper limbs are well defined, as are the conditions that influence the success rate.
• None of the organizations consulted specify the exact volumes required for granting microsurgical replantation practice privileges. Also, few facilities make public their criteria for granting medical privileges for microsurgical replantation. Among the few hospitals that were identified, the minimum annual replantation caseload varies from 2 to 5 cases.
• According to the surveys that were identified, hand surgeons recognize the importance of having sufficient exposure during training and their career in order to acquire microsurgical expertise. The annual caseload of those who perform upper extremity replantations or revascularizations varies from 5 to 10 cases.