Introduction: Once considered heroic and experimental, replantation and revascularization of acral parts has become excepted and routine at many medical centers worldwide. However, the reported results as concerns survial and function of replanted and revascularized parts have predominately been from tertiary medical centers. These reports represent the results of specialized teams including microsurgeons, fellows, residents and ancillary staff. Such results, while laudable, may not reflect the actual outcome and experience of the community hospital surgeon. The purpose of this study was to evaluate the replantation and revascularization experience of a single microsurgeon in solo practice in a community hospital environment.

Materials and Methods: Prospective data was gathered on all patients presenting to the author over a recent 12-month period at a 200 bed community hopsital for emergent replantation or revascularization of the forearm, hand and digits. Data gathered included age, sex, etiology, concurrent medical conditions, tobacco use history, ischemic time, method of part preparation and transportation, zone of injury, handedness, procedure performed, use of vein grafts, outcome and secondary procedures arising from failure of the intitial intervention. The system of Merle was used to classify distal digital amputations.

Results: During a recent 12-month period 51 patients presented to the author for emergent replantation and or revascularization of the digits, hand and forearm. Since the author was the sole provider of these services at the hopsital of contact, this series represents the entire institution's experience for the time period given. Among this cohort 94% were men.The mean age was 31.6 years. Concerning etiology there were three almost equal causes - knife (30%), crush-avulsion (34%), and power saw (33%). Zone of injury was confined in the majority of cases from Zone I (Merle zone IV-I) through III. A total of 67 digits and or limbs were operated upon. There were 41 replantations and 26 revascularizations. Ischemic time averaged 170 minutes. Fifty-eight digits and or limbs (87%) were successfully salvaged via replantation or revascularization. There were nine failed interventions (13%), all single digits with multiple levles of injury. No revascularization failed. Likewise no replantation of a sharply amputated part failed.

Conclusions: Over a 12-month period 67 digits and or parts were operated on emergently for replantation and or revascularization by a solo microsurgeon in a community hospital. A success rate of 87% was noted. All failed interventions were in crush-avulsion injuries. These results compare well with those reported by major tertiary centers.