Basic technical considerations in reattachment surgery.

Replantation surgery offers a rewarding challenge for one to apply basic biologic and functional concepts to deal with an infinite variety of amputation problems. Although there is an obvious requirement for technical skill, there is no place for stereotype procedures. Often the exact plan of treatment cannot be determined until debridement is completed, so by taking on the responsibility to manage these problems one must have not only fine technical skills but also a thorough knowledge and comprehensive experience in hand surgery, Upper limb amputations are complex and difficult compound hand injuries involving not only the vascular system but the bone, tendon, nerve, muscle, and skin as well. To entertain the concept that upper limb amputations are simply microvascular problems is indicative of a complete lack of comprehension of the realities of the situation. Every hand surgeon must add the ability to perform microsurgical techniques to his or her technical armamentarium, but to endorse the concept of a microsurgeon is bad for medicine and counter to both reality and concerned patient care.