Traumatic major limb amputations require urgent intervention to prevent irreversible tissue necrosis and life-threatening systemic complications due to warm ischemia. We aim to demonstrate the efficacy of extracorporeal circulation (ECC) in extending the ischemia tolerance window and stabilizing metabolic parameters during multidisciplinary replantation.

A 23-year-old female presented with bilateral total upper extremity amputations following a high-energy motor vehicle accident. While damage control surgery addressed intra-abdominal injuries, the amputated limbs were preserved using a neonatal oxygenator and a specialized ECC circuit. Perfusion was maintained for 224 minutes, achieving significant metabolic stabilization, with arterial pH improving from 6.72 to 7.57.

Although the right limb required secondary amputation due to the initial crush injury, the left limb was successfully salvaged. At the 3-year follow-up, the patient exhibited excellent functional recovery with restored motor and sensory functions.

ECC is a vital modality in complex trauma management, providing a metabolic bridge to replantation and improving long-term clinical outcomes in major limb salvage.