Classification and evaluation of the functional results of replanted parts of the hand at the Prince of Wales Hospital and the Prince of Wales Children's Hospital: 1984 to 1988

Abstract

This paper describes a simple method of classification and evaluation of the functional results of replanted and revascularized parts in the hand. The results are presented in graphic form and have been analyzed to correlate various factors: injured part, cause, and zone (level) of injury. The type of injury, ischemic time and age have been studied in more detail to determine their influence of the final functional result. The series contains 187 amputated and devascularized parts of the hand in 119 patients who have undergone surgery at the Prince of Wales Hospital from 1984 through 1988. The length of cold or warm ischemic times, up to 16 hours in this series, while not affecting survival of the amputated part, does adversely affect the functional result. The survival rate of replanted parts in children was significantly less favorable than in adults, but the functional results were uniformly superior.

Digital Avulsion With Compromised Vascularization

“…The recent series have reported only cases of amputation related to various mechanisms of injury including a few cases of avulsion, but with a higher global rate of success than in the past. 7,[9][10][11][12]15,16 The reported series of avulsion in adults and those regarding mixed mechanisms of amputation in children contrast with our daily experience and the very low success rate of revascularization of avulsed fingers in pediatrics. This prompted us to report on an exclusively pediatric series of avulsion injuries.…”

“…[15][16][17] These lower rates may be explained by attempts to salvage very severely damaged parts such as avulsion or amputation by extensive crushing injuries given that almost all victims of traumatic amputation are considered potential candidates for replantation. Avulsion, in particular, has not always been an indication for replantation, 16 because of extensive injuries to all of the digital tissues. The advent of microsurgery changed this, permitting avulsed digit replantations with varying rates of success depending on the type of lesions.…”

“…The advent of microsurgery changed this, permitting avulsed digit replantations with varying rates of success depending on the type of lesions. 12,16 The most challenging procedures are those for amputation with or without degloving because of the nature of vascular damage involving a long segment of the artery. To provide a more rational approach to the management of these injuries, various classification systems have been proposed.…”

Pediatric hand and wrist injuries

“…Overall, the results of replantation for finger amputations in children are excellent, with survival rates of nearly 98 % reported and functional recovery superior to that seen in adults [65][66][67][68][69][70]. However, a number of challenges remain.…”

“…However, avulsion injuries are particularly difficult to treat due to the significant soft tissue damage involved [65,68]. In fact, given the prognosis, whether or not revascularization should be attempted after complete degloving or amputation has been a matter of debate.…”