Evidence map›Paper›PMID 42077658›Full record

ReviewJPRAS open2026

Major limb replantation: Current status and perspectives.

Youssef Jaafar, Jack Obeida, Yanis Berkane, Loïc Van Dieren, Elio Nader, Javier Gonzalez, Ali Mojallal, Curtis L Cetrulo, Alexandre G Lellouch, Haïzam Oubari

Abstract readReview
PubMed Full text at PMC Publisher
In one paragraph

Review in JPRAS open, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

0numbers the graph read from it
0cells of the map it votes in
0citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

0 citing papers in PubMed.

No citing paper in PubMed yet.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

10 authors.

Youssef JaafarFaculty of Medicine and Medical Sciences, University of Balamand, Youssef Surock Street, Beirut 1100 2807, Lebanon.
Jack ObeidaDepartment of Plastic, Reconstructive and Aesthetic Surgery, CHU de Limoges, 2 Avenue Martin Luther King, Limoges 870432, France.
Yanis BerkaneCenter for Engineering in Medicine and Surgery, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA 02114, USA.
Loïc Van DierenCenter for Engineering in Medicine and Surgery, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA 02114, USA.
Elio NaderPoznan University of Medical Sciences, Faculty of Medicine, Ul Fredry 10, Poznan 61701, Poland.
Javier GonzalezDivision of Plastic Surgery Research, Vascularized Composite Allotransplantation Program Development, Cedars-Sinai Hospital, 8635 W. 3rd St, Los Angeles, CA 90048, USA.
Ali MojallalDepartment of Plastic, Reconstructive and Aesthetic Surgery, Hopital de la Croix Rousse - Hospices Civils de Lyon, 103 Grande Rue, Lyon 69004, France.
Curtis L CetruloShriners Children's Boston, 51 Blossom Street, Boston, MA 02114, USA.
Alexandre G LellouchCenter for Engineering in Medicine and Surgery, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA 02114, USA.
Haïzam OubariCenter for Engineering in Medicine and Surgery, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA 02114, USA.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

Background: Major limb replantation is a demanding microsurgical procedure aiming to restore form and function after traumatic amputation. Although survival has improved since the 1960s, ischemia, infection, and complex reconstruction continue to limit outcomes. Emerging preservation and reconstructive strategies may help expand indications and improve results. Methods: For this scoping review, MEDLINE, Embase, and the Cochrane Library were searched from inception through December 2024 using predefined MeSH terms related to major limb replantation. Adult case series and reports were included; pediatric cases and long-term follow-up studies were excluded. Screening and data extraction were conducted independently by three reviewers, with consensus resolution of discrepancies. Results: Ninety-nine publications reported outcomes in 1107 patients with traumatic amputations. The mean age was 31.6 years (range 17-63). Upper-limb replantation represented 88% of cases, most commonly at the forearm and elbow. Mean cold ischemia time was 10 ± 8 h and mean warm ischemia time 4.4 ± 2.3 h. Static cold storage was predominant (72%), while ex vivo dynamic perfusion and ectopic replantation were selectively applied. Overall replantation success was 68%, highest after sharp amputations (85%) and lower following crush (45%) and avulsion (55%) injuries. Vascular complications, infection, and systemic inflammatory response accounted for most failures. Conclusions: Major limb replantation remains constrained by ischemia-reperfusion injury and surgical complexity. New preservation techniques, adjunctive microsurgery, and optimized perioperative care show potential to improve viability and function. Continued multidisciplinary advancement is essential to strengthen outcomes and accessibility in both civilian and military trauma care.

Indexed as

Ex vivo perfusionIschemia-reperfusion injuryLimb preservationMajor limb replantationMicrosurgeryTraumatic amputation

Identifiers

PMID42077658
PMCPMC13133668

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.