Principios de evaluación y resultados funcionales en los reimplantes de miembro superior

Abstract

Palabras clave Reimplante miembro superior, Amputación miembro superior.

Functional Outcomes in Upper Limb Replantation—A Systematic Review

“…Although some general indications for replantation have been established [ 8 , 9 , 24 , 33 ], more recent studies have included new techniques such as delayed replantation [ 2 , 3 , 10 ], finding higher concordance in multiple toe, first toe, infant population and zone I long toe injuries. In the case of zone II long finger amputations, there is more controversy [ 7 ].…”

“…On the other hand, different studies point out the relationship between possible indications and contraindications and functional outcomes [ 1 , 7 ]. Poor prognostic factors for survival and function in replantation or reimplantation include crush/victimization, ischemia time, amputation level, major bone loss, loss of peripheral nerve supply, joint involvement, advanced age, being poor candidate for immobilization, unrealistic expectations or psychosocial disturbances and poor adaptation to rehabilitation [ 2 , 3 ].…”

“…It is striking that there is hardly any mention of the importance of hand therapy, in cases of reimplantation, to regain functionality. Few articles report that patients have been able to return to their pre-accident occupation/job after hand therapy [ 7 , 35 ]. And others point out the importance of care and rehabilitation programs to ensure a good postoperative period and reintegration into employment [ 7 , 40 , 41 ].…”

“…In general, we can differentiate the follow-up of function after replantation or replantation into different perspectives; although the objective results, in any type of amputation, of the degree of function may be low in some cases, the degree of subjective satisfaction is higher. Some authors [ 7 , 42 ] attribute this to the fact that reimplantation preserves bodily integrity while implementing positive emotional factors.…”

“…The principle of the optimization of results is currently being applied through the selection of patients who are candidates for these procedures. Some authors argue that functional results cannot be sacrificed for aesthetics or other aspects, so a reimplanted limb without adequate mobility or sensibility is not considered acceptable [ 2 , 3 , 6 , 7 , 8 , 9 , 10 ].…”