Disability and health after replantation or revascularisation in the upper extremity in a population in southern Sweden – a retrospective long time follow up

Abstract

Background: Replantation in the upper extremity is a well-established microsurgical procedure. Many have reported patients' satisfaction and functional measurements. The aim was to investigate the long time consequences as activity limitations in hand/arm, the general health and cold sensitivity after a replantation or revascularization in the upper extremity and to examine if sense of coherence (SOC) can be an indicator for rehabilitation focus. Methods: Between 1994-2008, 326 patients needed replantation/revascularization in the upper extremity. 297 patients were followed up. Information was collected from the medical notes and by questionnaires [Quick-DASH (disability hand/arm), EuroQ-5D (general health), CISS (cold sensitivity) and SOC (sense of coherence)]. Severity of injury was classified with the modified Hand Injury Severity Score (MHISS).Results: The patients [272 (84%) men and 54 (16%) women; median age 39 years (1-81 years)], where most injuries affected fingers (63%) and thumb (25%), commonly affecting the proximal phalanx (43%). The injuries were commonly related to saws (22%), machines (20%) and wood splints (20%). A direct anastomosis (30%) or vein grafts (70%) were used. The overall survival was 90%. 59% were classified as Major. Equal parts of the injuries took part during work and leisure, DASH scores at follow up were worse (p = 0.005) in the former. Twenty percent changed work and 10% retired early. Patients with early retirement were significantly older, had a more severe injury, worse disability, quality of life and functional outcome. Median DASH score was low [11.4 (0-88.6)] and correlated with severity of injury. Abnormal cold sensitivity (CISS > 50) was seen in 51/209 (24%) and they had a worse disability, quality of life, functional outcome and lower SOC. Patients with a low SOC had on the whole a worse outcome compared to patients with a high SOC and with significant differences in age, EQ-5D, Quick-DASH and CISS.Conclusions: A high MHISS, abnormal cold intolerance and a low SOC seems to be factors influencing the patients' outcome and might be relevant in the rehabilitation of the patients. Also, those who had to retire early had a worse disability, quality of life and functional outcome.

Cross-cultural adaptation of the World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0) for Hebrew-speaking subjects with and without hand injury

“…HI may result in long-term physical and functional disability, [6,8] limiting participation in a wide range of activities including daily, work, and leisure activities. [9,10] Moreover, HI may affect the ability to participate in various life roles such as husband or wife, caregiver and financial provider. [11] Furthermore, since a large share of HI are work-related, particularly among young males, [12] it is important to optimize recover in this group due to their long working life expectancy that requires a wide range of hand function.…”

Use of simulation in the rehabilitation of an anesthesiologist injured in the workplace

“…1 One-third of hand injured patients have to change work or retire early, and they were more often re-injured at work. 2 We studied the use of clinical simulation for hand therapy (HT) after thumb autograft in an anesthesiologist, providing psychologic, physical, and functional measures during the process. We expected this strategy would facilitate readaptation to clinical demands and would be effective for an early and safe return to work.…”

Description and cost‐analysis of emergency department attendances for hand and wrist injuries

“…Injuries to the hand and wrist are common, with reports suggesting that they account for between 10% and 30% of all ED presentations, and typically affect young and economically productive populations . Although most uncomplicated injuries will recover fully, accurate assessment and treatment are vital as mismanagement can result in delayed recovery and potential long‐term disability at a significant cost to the individual, healthcare system and society …”

“…1,4 Although most uncomplicated injuries will recover fully, accurate assessment and treatment are vital as mismanagement can result in delayed recovery and potential long-term disability at a significant cost to the individual, healthcare system and society. [3][4][5][6][7] The administration of the Australian healthcare system is complex, involving all three levels of government in addition to other stakeholders that include private and public service providers. 8 The Australian government has a responsibility for the tax-funded universal public health insurance scheme, Medicare, which involves subsidising medical services, such as public ED funding, and providing some funding for private health networks.…”