ABSTRACT
The experiences gained from two clinical cases of incomplete amputations through the thigh in May 1958 and August 1959 generated several projects in experimental limb replantation in dogs in the fall of 1959 in the orthopaedic clinic at Nara Medical University in Nara, Japan. Experiments on 500 limbs focused on such problems as the time of amputation ischemia, preservation and resuscitation procedures, replantation technique, replantation toxemia, and the postoperative functional recovery of replanted limbs. 3 The patency rate of anastomosed blood vessels less than 3 mm in external diameter was very low using macrovascular instruments and suture material. With the development of Inokuchi 's blood vessel stapler, success rates markedly increased. Coincidentally, Lapchinsky4 in Russia and Snyder and Knowles 5 in the United States were working on the same model. Inspired by Jacobson's use of the microscope for small vessel repair in 19606 and encouraged by Malt's successful arm replantation in 1962, 7 we began microvascular research ourselves in 1964. We asked the members of the local medical association to send all amputated digits or hands to our unit. After many failures, in July 1965 Komatsu and I8 succeeded in replanting a completely amputated thumb at the metacarpophalangeal joint level in a 28-year-old man. Two arteries and two veins were anastomosed under a Zeiss operating diploscope using 8-0 monofilament nylon and 7-0 braided silk sutures. The entire operating time was 41fz hours. The thumb survived uneventfully. When the case was presented at the ninth meeting of the Japanese Society for Surgery of the Hand in March 1966 in Tokyo, it was received with incredulity by most of the audience, who could not appreciate that vessels of less than I mm in diameter could be successfully anastoFrom the Department of Orthopaedic Surgery, Nara Medical University, Kashihara, Nara, Japan. Presented at the 36th Annual Meeting of the American Society for Surgery of the Hand, Las Vegas, Nev., Feb. 23-25, 1981. Received for publication Feb. I, 1982. Reprint requests: Susumu Tarnai, M.D., Department of Orthopaedic Surgery, Nara Medical University, Kashihara, Nara, 634 Japan. mosed under a microscope. In November 1967, I was invited to join a panel on microsurgery at the American Society of Plastic and Reconstructive Surgeons in New York by Dr. Harry J. Buncke, who was also interested in experimental replantation. 9 This case report created a sensation as the world's first successful replantation of a completely amputated digit, although Kleinert and Kasdan 10 had replanted an incompletely amputated thumb in 1962. Since then, reports on limb and digit replantations have appeared in medical journals throughout the world. 11 This report represents my personal experiences with 293 upper extremity replantations among 302 extremity replantations performed between May 1958 and December 1980.