Long-term outcome following upper extremity replantation after major traumatic amputation

Abstract

BackgroundAmputations in general and amputations of upper extremities, in particular, have a major impact on patients’ lives. There are only a few long-term follow-up reports of patients after macro-replantation. We present our findings in contrast with the existing literature.MethodsSixteen patients with traumatic macro-amputation of an upper extremity were eligible for inclusion in this study. Altogether, the patients underwent replantation in 3 institutions between 1983 and 2011.ResultsTwelve male and four female patients with an average age at injury of 40.6 years (range, 14–61 years) were included in this study. The mean follow-up period was 13.5 years (range, 4.4–32.6 years; SD, 5.7 years). The mean disabilities of the arm, shoulder and hand (DASH) outcome measure was 41 (range, 5.2–94.8; SD, 18.2), functional independence measurement (FIM) was 125 (range, 120–126; SD, 1.8). Chen I representing very good function was accounted in six, Chen II representing good function in eight, Chen III (fair) in one and Chen IV (bad function) in one patient.ConclusionsWe found that while the majority of the included patients exhibited good or very good function of the extremity, none of the replanted appendages regained normal levels of functionality. In addition, all participants were very satisfied with their outcomes. Positive long-term results with high rates of subjective satisfaction are possible after replantation of upper extremities.

Ex vivo limb perfusion for traumatic amputation in military medicine

“…The first was the Lower Extremity Assessment Project (LEAP) [6], which focused on civilian healthcare. The results suggest that the functional outcomes of reconstruction and amputation are at least similar among civilians being treated for major lower-extremity trauma [3,4,7]. Regardless of the type of treatment, LEAP outcomes were not optimal, with one-half of injured civilians reporting high levels of disability.…”

“…The results of replantation surgery vary depending on the cause of the amputation, the patient's condition and the quality of the specialized service provided. Furthermore, recent evidence underlines the role of allotransplantation of limbs in opposition to prosthetic limb replacement regarding functional outcomes and patient satisfaction [3,4]. Replantation surgery is a highly elaborate microsurgical procedure that requires optimal interdisciplinary cooperation within an experienced team (for the aftercare as well).…”

“…The incidence of polytraumatized patients with life-threatening extremity injuries is increasing [5]. Especially in these cases, the strategy of "life before limb" damage control surgery within the short post-traumatic timeframe hinders replantation, which is partly defined by the limited ischemic time for successful replantation [4,5]. This approach is basically equivalent between civilian and military trauma care.…”

Forearm replantation after traumatic complete amputation

“…Limb amputation causes not only loss of physical integrity but also affects an individual’s mental and social well-being and is a significant problem, especially for younger people and the working population 1. The success rate for replantation after major upper extremity amputation is reported in 77%–93% 2. The success rate depends considerably on the grade of damage.…”

Characteristics of Secondary Procedures following Digit and Hand Replantation

“…Replants often have restricted function that differs from the premorbid hand. 9,10 Traumatic amputation and operative replantation result in an inflammatory injury response resulting in scar formation, joint contractures, and tendon adhesions. 11,12 Direct trauma may also result in bone loss, joint destruction, and segmental tendon/nerve injury that impairs normal hand function.…”