ORIGINAL SCIENTIFIC REPORT Parathyroid Reimplantation in Forearm Subcutaneous Tissue During Thyroidectomy: A Simple and Effective Way to Avoid Hypoparathyroidism Giuseppe Cavallaro 1 • Olga Iorio 1 • Marco Centanni 1 • Natale Porta 1 • Angelo Iossa 1 • Lucilla Gargano 1 • Susanna Del Duca 1 • Angela Gurrado 2 • Mario Testini 2 • Vincenzo Petrozza 1 • Gianfranco Silecchia 1 Ó Socie ´te ´ Internationale de Chirurgie 2015 Abstract Introduction Parathyroid autotransplantation plays an important role in preventing hypoparathyroidism following thyroidectomy. The preferred reimplantation site is still the sternocleidomastoid muscle, but this approach does not permit to check graft vitality postoperatively. The authors report the first prospective evaluation of normal parathyroid gland reimplantation in forearm subcutaneous tissue (using the same technique proposed during parathyroidectomy for hyperplasia) in case of devascularized or inadvertently removed glands during thyroid surgery. Materials and methods From January 2013 to August 2014, we performed 348 consecutive thyroidectomies for various disease, both benign and malignant. In 25 cases, due to inadvertent parathyroid removal or evidence of insufficient blood supply, we removed and fragmented the gland into 0.5–1 mm slices (one for frozen section) and reimplanted it into two subcutaneous pockets on the non-dominant forearm. After surgery we checked grafted gland function by evaluation of serum parathormone gradient between reimplanted versus non-reimplanted arm (consid- ering significant a ratio of 1.5 or more), at 1 week, 1 and 3 months after surgery. Results We observed recovery of reimplanted graft function in 48, 88 and 96 % of patients respectively at 1 week, 1 and 3 months after surgery. All patients showed normal parathormone levels in peripheral blood (non-reimplanted arm). In one case we observed post-operative wound hematoma on graft-site. This patient showed no graft func- tionality in post-operative period (even at 3 months follow-up). Conclusions Parathyroid gland reimplantation in forearm subcutaneous tissue during thyroid surgery is a safe, easy and effective procedure; furthermore, it allows a good control of graft functionality and would allow an easy grafted gland removal if needed. Introduction Parathyroid autotransplantation, first described in 1908 in animal models [1], has not been widely considered of clinical utility until the last decades [2, 3], when it has been proposed to preserve parathyroid function after parathy- roidectomy for secondary hyperparathyroidism, primary parathyroid hyperplasia, recurrent or persistent hyper- parathyroidism. Today this technique plays an important & Giuseppe Cavallaro giuseppe.cavallaro@uniroma1.it 1 Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Corso della Repubblica 79, 04100 Latina, LT, Italy 2 Department of Biomedical Sciences and Human Oncology, University of Bari, Bari, Italy 123 World J Surg DOI 10.1007/s00268-015-3070-0