Measuring Outcomes and Determining Long-Term Disability after Revision Amputation for Treatment of Traumatic Finger and Thumb Amputation Injuries

Giladi, Aviram M.; McGlinn, Evan P.; Shauver, Melissa J.; Voice, Taylor P.; Chung, Kevin C.

doi:10.1097/prs.0000000000000591

Cited by 45 publications

(35 citation statements)

References 37 publications

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“…3,4,9 If the finger is not replanted recovery following revision amputation is relatively short and function is largely retained. 10 However, proximal amputations can cause functional deficits, and psychological problems may arise after amputations at any level. There is also little data regarding the appropriate indications for replantation.…”

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confidence: 99%

Direct-to-Implant Single-Stage Immediate Breast Reconstruction with Acellular Dermal Matrix

Gdalevitch

Genoway

et al. 2014

Plastic &Amp; Reconstructive Surgery

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Purpose-Large geographic differences in utilization of a procedure draw into question its appropriate use. In Japan, replantation is commonly conducted for even very distal finger amputations. In the US, revision amputation is far more common. There has been no detailed investigation into the drivers of these differences.Methods-We created a survey to assess surgeons' experience with replantation, estimates of physical and functional outcomes, attitudes toward amputees, and preferences in several injury scenarios. The survey was distributed to members of the Finger Replantation and Amputation Multicenter (FRAM) Study and to hand surgeons making podium presentations at the Central Japanese Society for Surgery of the Hand Annual Meeting.Results-100% of both groups responded. There were no significant differences in experience with finger replantation. Japanese hand surgeons were significantly more likely to recommend replantation in all scenarios, despite 62% ranking function 6 months after replantation as "poor." Japanese surgeons rated the appearance of a hand with an amputated finger significantly poorer than American surgeons. Japanese surgeons were also significantly more likely to report stigmatization against finger amputees.Conclusion-There is no high level of evidence study comparing outcomes following replantation and revision amputation. The lack of evidence results in surgeons basing recommendations on personal preference. In this case, Japanese surgeons preferred replantation despite agreeing that functional outcomes were suboptimal. This may be because of Japanese cultural beliefs. Comparative effectiveness research, like that planned by the FRAM study, can help elucidate the appropriate utilization of finger replantation based on evidence.Corresponding author and reprint requests sent to: Kevin C Chung, MD, MS, Professor of Surgery, Section of Plastic Surgery, Assistant Dean for Faculty Affairs, University of Michigan Medical School, 2130 Taubman Center, 1500 W Medical Center Dr, Ann Arbor, MI 48109-0530, Phone: 734-615-3435, kecchung@umich.edu. Hand injuries pose a worldwide burden. Much of the world relies on manual labor such as farming and factory work for sustenance and income. In these cases, revision amputation, which allows for quicker return to work while largely maintaining function, is the preferred treatment. Despite more oversight by many countries in developing safety measure to protect workers, amputation of digits occurs frequently, even in highly developed countries such as the US and Japan. In these regions surgeons are engaged in intense microsurgical training and have access to advanced surgical technology and are able to replant amputated digits successfully. The use of this procedure is variable, however. In Japan and other parts of Asia, ever expanding indications for finger replantation mean the procedure is performed with increasing frequency. 3,4 In contrast, finger replantation is performed by a small fraction of hand surgeons at only 15% of American hospitals. 5,6...

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Direct-to-Implant Single-Stage Immediate Breast Reconstruction with Acellular Dermal Matrix

Gdalevitch

Genoway

et al. 2014

Plastic &Amp; Reconstructive Surgery

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“…69,70 With the addition of an aesthetic element and greater focus on satisfaction and HRQL, the MHQ often correlates more strongly to mental health outcomes than other upper extremity questionnaires. 39 Although the impact of this finding is not yet clear, especially as it relates to measuring quality of overall care and long-term disability, it illustrates how across validated PROs there can still be variations in the findings. Understanding the different benefits and downsides of the questionnaires helps in choosing the appropriate metric to use for each research question.…”

Section: Validation Of Prosmentioning

confidence: 97%

“…Impairment is defined as “an alteration of an individual’s health status – a deviation from normal in a body part or organ system and its functioning,” whereas disability is defined as “an alteration of an individual’s capacity to meet personal, social, or occupational demands because of an impairment.” 37,38 For some patients they are related, but in many cases, a patient’s anatomic impairment does not correlate to their degree of disability. 39,40 Some with less severe injuries are functionally limited, yet others with mutilating injuries find ways to return to useful function even with severe impairment. 41 This gap is often accentuated when evaluating patients with external pressures to optimize function.…”

Section: Measuring Outcomesmentioning

confidence: 99%

“…In this study, finger amputation patients performed functional tests and completed PRO questionnaires. 39 They also had anatomic injury (“impairment”) measured based on a standardized weighting system by digit and length lost. The patients then performed complex functional tasks as a measure of their ability to perform ADLs and as a way to reflect overall disability.…”

Section: Validation Of Prosmentioning

confidence: 99%

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Measuring Functional and Patient-Reported Outcomes After Treatment of Mutilating Hand Injuries

2016

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SYNOPSIS Understanding the global burden of trauma, particularly upper extremity trauma, is necessary in addressing the global need for surgical services. Critical to that mission is to understand, and accurately measure, disability and related Disability Adjusted Life Years (DALY) resulting from massive upper extremity trauma. This is particularly important in developing nations, where these injuries occur more frequently, and social services to support the disabled are not available. The impact of these injuries on patients and on society is magnified when considering that they frequently occur to young people in their prime working years. In this article, we discuss these social and medical system issues. We also review components of a comprehensive approach to measuring outcomes after these injuries. Patient reported outcomes are highlighted, as they provide unique insights into quality of life and mental health components central to understanding composite disability, and must be used in outcomes evaluations for the mutilating upper extremity injury patient. Methods of optimizing outcomes measurements and studies, disability assessments, and associated research are also discussed.

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“…3, 4, 9 If the finger is not replanted recovery following revision amputation is relatively short and function is largely retained. 10 However, proximal amputations can cause functional deficits, and psychological problems may arise after amputations at any level. There is also little data regarding the appropriate indications for replantation.…”

mentioning

confidence: 99%

Traumatic Finger Amputation Treatment Preference among Hand Surgeons in the United States and Japan

Shauver

Nishizuka

Hirata

et al. 2016

Plastic &Amp; Reconstructive Surgery

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Purpose Large geographic differences in utilization of a procedure draw into question its appropriate use. In Japan, replantation is commonly conducted for even very distal finger amputations. In the US, revision amputation is far more common. There has been no detailed investigation into the drivers of these differences. Methods We created a survey to assess surgeons’ experience with replantation, estimates of physical and functional outcomes, attitudes toward amputees, and preferences in several injury scenarios. The survey was distributed to members of the Finger Replantation and Amputation Multicenter (FRAM) Study and to hand surgeons making podium presentations at the Central Japanese Society for Surgery of the Hand Annual Meeting. Results 100% of both groups responded. There were no significant differences in experience with finger replantation. Japanese hand surgeons were significantly more likely to recommend replantation in all scenarios, despite 62% ranking function 6 months after replantation as “poor.” Japanese surgeons rated the appearance of a hand with an amputated finger significantly poorer than American surgeons. Japanese surgeons were also significantly more likely to report stigmatization against finger amputees. Conclusion There is no high level of evidence study comparing outcomes following replantation and revision amputation. The lack of evidence results in surgeons basing recommendations on personal preference. In this case, Japanese surgeons preferred replantation despite agreeing that functional outcomes were suboptimal. This may be because of Japanese cultural beliefs. Comparative effectiveness research, like that planned by the FRAM study, can help elucidate the appropriate utilization of finger replantation based on evidence.

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Measuring Outcomes and Determining Long-Term Disability after Revision Amputation for Treatment of Traumatic Finger and Thumb Amputation Injuries

Abstract: Risk, II.

Cited by 45 publications

References 37 publications

Direct-to-Implant Single-Stage Immediate Breast Reconstruction with Acellular Dermal Matrix

Direct-to-Implant Single-Stage Immediate Breast Reconstruction with Acellular Dermal Matrix

Measuring Functional and Patient-Reported Outcomes After Treatment of Mutilating Hand Injuries

Traumatic Finger Amputation Treatment Preference among Hand Surgeons in the United States and Japan

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