Table 6.

Lessons that can be learned from replantation and transplantation.

1. Motor	● More extensive occupational therapy is likely beneficial ● Immunosuppression may help nerve recovery independent of anti-rejection effects ● Balancing muscle and tendon lengths is difficult but important ● Upper limbs are very helpful to lower limb rehabilitation
2. Sensation	● Discriminatory sensation is frequently attainable ● Sensory recovery continues for years
3. Cosmesis	● Significant psychosocial benefit from being seen to have hands ● Ensuring appropriate and similar length limbs is important
4. Patient Satisfaction/quality of life	● There is an exponential disability with bilateral versus unilateral limb loss ● Setting realistic expectations is important ● Patients may have goals that are not obvious to the medical/surgical team (e.g. improved balance, temperature regulation, fitting clothing)
5. Adverse events/complications	● Complications are very common ● Hands are very susceptible to ischemia as they are “end organs” ● Patient selection is critical to minimize adverse outcomes ● Planning is essential to limit complications ● A well-trained medical/surgical team who work well together is enormously helpful ● Ischemia likely causes poor later function (contributes to muscle fibrosis) ● Always consider life over limb when deciding whether to proceed
6. Financial costs	● Financial costs of limb restoration are on par with other complex medical/surgical interventions ● The cost of a disability may be much higher than that of direct medical care
7. Overall function	● Absolute scores on functional assessments are not as important as the change in score (i.e. more disabled patients stand to gain more from replantation/transplantation)