EUROPEAN SURVEY REGARDING INDICATIONS AND CONTRAINDICATIONS FOR REPLANTATION OF THE UPPER LIMB.pdf 1. The most important informations before thetransfer of the patient to the unit in case of secondaryreferral are: Age (68,75 %); Affected Side (65,63 %); Level (68,65 %); Associated Traumas (68,65 %). No consensus for: Time Of Accident, Type OfInjury, Local Temperature, Bacterial Or ChemicalContamination / Physical damage, Blood And X-RayExamination, Associated Diseases, Ischemia Time, Patient’s motivation, Psychological Statu, All of them. 2. The required informations should be provided before transfer if possible but it is not mandatory (71,88 %). No consensus for: Yes, Mandatory before accepting the patient, No, it will not change acceptation of the patient. 3. An hypothermic (with refrigerated amputated segment) ischemia period: > 6 hours for macroreplantations (segments containing muscles) and > 12 hours for micro-replantations: a) is not an absolute contraindication for micro-replantation (75,00 %) and b) is not an absolute contraindication for macro-replantation (65,63 %). 4. A normotermic (with amputated segment atroom temperature) ischemia period: > 4hours for macroreplantations (segments containing muscles) > 12hours for micro-replantations is not an absolute contraindication for macro-replantation (65,63%). No consensus for: is an absolute contraindication for micro-replantation, is a relative contraindication for: micro-replantation, is a relative contraindication for: macro-replantation, is not a controindication for micro-replantation, is not a controindication for macro-replantation. 5. Only polytrauma (ISS > 15) and organ transplanted patients are relative general contraindications to replantation (68,75 %). No consensus for: Head Injury (commotivetrauma or bad G. C.S.), Age > 70, Self inflicted injury, Psychiatric disorders, Smoking (not to be consideredthe occasional smokers), Alcohol overuse, Diabetes. 6. Multiple level injuries (with multiple vascular lesions) (65,63 %), avulsions ( with traction lesions of several structures: nerves, vessels, tendons, etc.) (68,65 %) and prolonged ischemia time (> 4 hours in macroreplantation .>12 hours for microreplantation (68,75 %) are relative local contraindication to replantation. No consensus for: Crushing ( with extensive tissue damage precluding revascularization with a direct suture), High bacterial contamination, Physical lesion - chemical contamination (frozen burned limbs, contaminated by chemical agen). 7. The following guide-lines regarding the preservation and transportation of amputated segments are important (75,00 %). 8. Single digit replantation (except thumb): (from MP to P2). No consensus for: Is replantation of a single digit indicated? 9. Distal (distal to FDS insertion) replantation (except thumb). No consensus for: Is distal replantation indicated? 10. Multiple digits (> 2 fingers) replantations. No consensus for: Do you believe that for this type of replantation a special organisation is required ? (double equipe?) 11. The thumb should always be replanted (84,38 %). 12. Age > 70 years (78,13 %), smoking (71,88 %) and a distal amputation (68,75 %) are not contraindications to thumb replantation (68,75 %). No consensus for: Polytrauma (ISS > 15), Crushing, Avulsion. 13. Very proximal level of injury (proximal to the elbow) (71,88 %), transarticular amputations (78,13 %) and amputations through neuromuscularjunction (68,75 %) are not local contraindications for major limb replantation. No consensus for: Multiple level, Type of injury: crush, avulsion. 14. A standardized protocol of adjuvant medical therapy in replantation is useful (81,25 %) and should include heparin (65,63 %) and acetylsalicylic acid (78,13 %). No consensus for: Low-molecular weight dextran, Sympathetic blocks, Vasodilators. 15. Leeches as non medical adjuvant therapy in microreplantations are useful (75 %). No consensus for: Decongesting incisions, Nail-bed incisions. 16. The useful indicators to assess the final results after replantation surgery are: SemmesWeinstein sensibility test (68,75 %), Motor functionof the reinnervated muscles (78,13 %), Articularrange of motion (active and passive) (75,00 %), Pinch and Jamar test (68,75 %), DASH or other objective / subjective evaluation (71,88 %). No consensus for: Weber sensibility test, Cold intolerance, All of them. 17. The complications to be used as parameters to value indications to replantation are: % of survival (75,00 %) and poor motor and sensory function (65,63 %). No consensus for: % of infections, % of intolerance, % of non union, All of them. 18. The best classifications to assess functional results in upper limb replantations are: Jones 1982 (65,63 %) and Blomen 1988 (65,63 %). No consensus for: Chen 1978, Berger 1980, Tamai 1982/1983, Milroy 1991.

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