6% of the cases. In the specific cases of multiple finger Crizotinib clinical amputations, another surgical technique that can be used is heterotopic replantation. This technique was used in 8.3% of the cases of digital replantation included in this study. Primary coverage with microsurgical flaps was necessary in 8.3% of the cases. (Figure 2) Figure 2 Surgical techniques applied. Of the 43 cases, four had to be readdressed for review of the microsurgical anastomoses. Of these, one case evolved with survival of the limb and three cases with regularization after loss of replantation, which results in a survival rate of 93%. As regards the last item of data analyzed, but not the least important, we sought to estimate patient satisfaction with the replanted limb.

Not all the patients are fully satisfied in terms of function expected for the replanted limb, but all the patients declare they are more satisfied having their original limb replanted than making use of prostheses. DISCUSSION Since 1962, the year in which the first successful replantation was described in the world, surgical techniques in replantation and microsurgical techniques have evolved at a surprising speed.3,5,18 Thanks to the advances of instruments, optics and specialization among microsurgeons, today we have access to a technology that allows us to acquire a wealth of details and affords the dexterity to perform microsurgeries with increasing safety and success. In replantation cases, factors that previously represented absolute contraindications for its performance, due to microsurgical technical advances, are currently relative contraindications.

2,9,10,19 Technically speaking, replantation after avulsion injuries is more laborious,7 but can be executed by a qualified microsurgeon, and it is possible to use various microsurgical techniques. In the bibliographical survey carried out for the performance of this trial, we did not find many case series with such a significant casuistry as that obtained in our study. We believe that the shortage of studies referring to replantation in amputations after avulsion injuries is due to the fact that until recently avulsion injuries were considered a contraindication to the replantation procedure.12 In evaluating the results obtained in this study, we observed that the average age was 26 years. Most of the patients were of working age, and suffered accidents during the work period.

Male predominance, the greater Entinostat involvement of the upper limbs and of the dominant side (right, in the majority of the population), reinforces the idea that the population most susceptible to traumatic amputations is made up of manual workers. The greater frequency of involvement of the male sex, between the third and fourth decades of life, was also observed in other studies.4,8,20,21 The level of amputation that predominated in this study, was amputation of the thumb (23 of the 43 cases).