Hand replantation after 54 hours of cold ischemia: a case report.

A number of case reports and series have reported successful replantation after prolonged periods of ischemia. However, the acceptable range of normothermic and hypothermic ischemic storage remains controversial. There is little question that the tolerance of composite tissue for ischemia is dependent on the quantity of contained skeletal muscle. We report a successful hand replantation after 54 hours of cold ischemia. We believe that this case documents the longest anoxic period yet reported for successful hand replantation. We further believe that the functional results obtained confirm the value of hand replantation even after such a prolonged ischemic interval.