Functional Outcomes of Major Upper Extremity Replantation: A Scoping Review

Abstract

Background: Traumatic upper limb amputations proximal to the carpus are devastating injuries. Existing literature on outcomes following replantation is limited. Our objective was to perform a scoping review of (1) functional outcomes; (2) return to work data; and (3) secondary surgeries required following proximal to carpus replantation. Methods: A literature search of MEDLINE, EMBASE, Cochrane, and CINAHL was performed according to PRISMA guidelines. All studies reporting on functional outcomes, return to work, or secondary surgeries following replant of traumatic proximal to carpus amputation were included. Results: Of the 753 articles, 13 studies were included, accounting for 136 major upper extremity replants (0 shoulder, 36 arm, 14 elbow, 86 forearm). Average age was 35 (24 -47) years, with average follow-up of 8 years (2 -18). Chen's Functional Criteria was the most common tool for reporting outcomes (10/13). Level of injury was related to functional outcome, with excellent to good Chen scores for replants distal to elbow, and poor Chen scores for replants at or proximal to elbow. Return to work correlated with level of replantation, with successful return for 65% of forearm, 43% of elbow, and 32% of arm replants. A mean of 2.4 secondary procedures were required. Conclusions: This study provides insight into major upper extremity replantation, to assist in patient counseling and surgical decision making. Good functional outcomes and successful return to work are directly related to level of injury following major upper extremity replant. Patients should be counseled that more than 1 secondary procedure may be required.

Complex Korean Medicine Treatment after Elbow Replantation Following Traumatic Amputation: A Case Report

“…This study reported a single case in which the follow-up period was not long and the most effective treatment was unknown. The outcome of this patient is not so good, considering the previous review that the average DASH score was 40.4 regardless of the replantation level, and 21% of elbow replantation was graded 4 (Poor) by Chen's functional criteria [4]. Changes in the patient's pain were not quantitatively identified because they changed frequently.…”

“…However, only a few studies were reported on upper extremity replantation worldwide. A previous review revealed that the number of elbow replantation was the lowest, accounting for approximately 10% of study participants among the upper extremities, making this case relatively rare [4]. This study is different in that it specifically described the patient's progress in the short term while previous studies followed up in the long term over several years.…”

“…A previous review indicated only 12 retrospective reviews and 1 case series worldwide on upper extremity replantation proximal to the wrist, from 2000 to Januar y 2019. Most studies explored the surgical method, postoperative management, and long term follow-up of >2 years, with very few records on the treatment and management after the acute phase [4]. Further evidence on the progress of treatment from the acute to the subacute stage and various therapeutic approaches are needed because the accurate prediction of a patient's chronic pain and dysfunction in the acute phase is limited [5].…”

Major traumatic amputations and replantations of the upper extremity in Germany – National quality reports 2014–2018

“…The lower replantation numbers, proximal to the elbow, might be amongst others attributed to the known less favourable functional replantation outcomes at these proximal levels. 10 , 11 , 12 …”

Makroamputationsverletzungen – der Weg zur technisch und funktionell erfolgreichen Replantation

“…Bewertet wird das Ergebnis einer erfolgreichen Replantation primär durch den Unfallverletzten und sein engstes soziales Umfeld, während die objektive Beurteilung die funktionellen Ergebnisse nach Chen et al beinhaltet 2 , 15 , 16 , 17 , 18 .…”