ORIGINAL PAPER Replantation and revascularization of the upper extremity: clinical experience of a microsurgical department in Portugal Tiago Guedes 1 & Marta Azevedo 1 & João Morais 1 & Carolina Andresen 1 & Gustavo Coelho 1 & Horácio Zenha 1 & Horácio Costa 1 Received: 1 August 2018 / Accepted: 22 February 2019 # Springer-Verlag GmbH Germany, part of Springer Nature 2019 Abstract Background Since the pioneering works of Malt and Komatsu and Tamai in the 1960s, thousands of replantations and revascu- larizations of the upper extremity have been performed worldwide. The advent of microsurgery allowed surgeons to replant or revascularize essentially any amputated part. However, the mechanism of injury or patient comorbidities are important factors that can affect the outcomes. Methods Patients submitted to upper extremity replantation or revascularization between 2014 and June 2018 were retrospec- tively analyzed. Demographic features, type of accident, mechanism of injury, amputation level, and success rate were examined. Results Over the 4.5-year period, 45 replantations and 20 revascularizations were performed. The vast majority of patients were male. The mean age was 45.7 years old in the replantation group and 49.2 years old in the revascularization group. In both groups, the crush/avulsion injury was the most common mechanism. The overall success rate was 57.8% in replantation and 75% in revascularization. The failure in the replantation group was mainly due to arterial insufficiency. Conclusions The success of revascularization is higher than replantation; however, the mechanism of injury seems to be a critical determinant of the outcome. Level of Evidence: Level IV, therapeutic study. Keywords Upper extremity . Replantation . Revascularization . Microsurgery Introduction The experimental replantation of amputated parts in animal models dates back to the beginning of the twentieth century; however, it was not until the 1960s that clinical replantation occurred in humans. In May 1962, Malt and McKhann per- formed the first successful replantation of an arm on 12-year- old boy victim of a train accident, at the Massachusetts General Hospital in Boston [1]. In 1968, in Japan, Komatsu and Tamai performed the first successful digit replantation using microvascular anastomoses [2]. Since then, with the development of increasingly refined microsurgical instru- ments and techniques, allied to magnification devices, thou- sands of replantations and revascularizations are performed worldwide. Replantation can be defined as the reattachment of a completely amputated part by restoring arterial and venous flow and reconstruction of nerve and musculoskeletal struc- tures. However, amputation can be incomplete and associated with distal devascularization, and in this case, the goal is to restore extremity vascularization through microvascular tech- niques. The distinction between replantation and revasculari- zation is critical, because viability rates are generally higher in revascularizations, since venous drainage tends to be pre- served [3]. The success of a replantation depends on several factors such as age, level and type of injury, ischemic time, expected functional outcome, and comorbidities of the patient. Distinguishing between macro- and microreplantation (ampu- tations proximal or distal to the wrist, respectively) is an * Tiago Guedes guedes.tiago87@gmail.com 1 Department of Plastic, Reconstructive, Craniomaxilofacial Surgery and Microsurgery Unit, Gaia Hospital Center and Aveiro University, Rua Conceição Fernandes, s/n, 4434-502 Vila Nova de Gaia, Portugal European Journal of Plastic Surgery https://doi.org/10.1007/s00238-019-01520-2