Quality of life and reconstructive surgery efforts in severe hand injuries

Abstract

Introduction:Severe hand trauma, leading to extensive skeletal and tissue defects, requires plastic surgical reconstruction of the highest level aiming at maximizing function and aesthetics. The intention of this study was to investigate clinical parameters and resource consumption connected with severe hand injuries, with specific emphasis on a follow-up evaluation of quality of life after the reconstruction process.Materials and methods:In this retrospective study, we evaluated patients with severe hand injuries from 2013 to 2016 who had completed surgical and non-surgical treatment. Measures included total period of therapy (TPT) in days, total duration of operations including anesthesia (TOA), total duration of all operations (TO), and total number of operations (TNO). We also determined total inpatient stay (TIS), total number of clinic presentations with interventions (TNPI), initial hand injury severity score (iHISS), and inpatient proceeds (IPP) in Euros (€). Correlation was assessed between iHISS and TOA, TNO, and TIS. Finally, these patients were reexamined in a follow-up inquiry and the life quality was assessed with the five-level version of the EuroQol five-dimensional (EQ-5D) descriptive system (EQ-5D-5L).Results:We analyzed 12 patients with an average age of 44 years (min. 24 years, max. 75 years). Patients receiving reconstructive surgery experienced median (${\rm{\tilde x}}$) TPT of 175 days [interquartile range (IQR), 51–499], TOA of 13 h (IQR, 6–37), TO of 9 h (IQR, 4–25), and TNO of 5 (IQR, 3–11). Further, the patients’ median TIS was 22 days (IQR, 9–86), TNPI was 4 (IQR, 2–8), and iHISS was 77 (IQR, 44–162). The median IPP was 14.595 € (IQR, 5.541–33.709 €). IHISS was positively correlated with Pearson’s r for TIS (0.817), TOA (0.857), and TNO (0.871). The EQ-5D-5L index value resulted in a high level of life quality with a median of 0.898 (min. 0.8, max. 1).Conclusion:Severe hand injuries are related to high efforts for surgical and functional reconstructions, which result in high quality of life measured with the EQ-5D-5L assessment. However, for a defined collective of patients, myoelectric prosthetic functional replacement should be considered. Further studies are necessary to examine functional outcomes and quality of life after bionic prosthetic replacement. Also, a bionic reconstruction score to define hard criteria for taking an acute treatment decision is necessary.

Hand Bionic Score: a clinical follow-up study of severe hand injuries and development of a recommendation score to supply bionic prosthesis

“…Clear perfusion damage of the tissue and lack of possible revascularization are hard criteria for amputation of the affected tissue. However, for areas that have suffered massive damage but are eligible for preservation, it is difficult to decide whether early amputation and bionic prosthetic care will benefit with shorter inpatient stay, interval for outpatient follow-up, and time to reintegration in professional life [15]. In addition to post-traumatic stress disorder associated with acute hand trauma, the need for repetitive corrective interventions also causes other psychological disorders such as anxiety, depression, and social isolation caused by disfigurement and pain [43][44][45][46].…”

“…In addition, interpersonal perceptions of patients with bionic technologies can vary based on the technology [14]. Although the aim of reconstructive surgery is to restore esthetic and function by reconstructing anatomical structures, the reconstructive process is long and elaborate and may not result in the desired functionality and appearance [15].…”

Functional Compatibility of Local Flaps for Coverage of Digital Skin Defects

“…The overall outcome in which all five parameters were achieved was 87.5 % with the main aim being resumption of daily activities in a shorter time and with minimal short term and long term complications. [13][14][15] These local flaps were able to achieve adequate wound coverage in almost 97% of defects making them a very reliable coverage option. Jiao et al in their article of clinical experience of multiple flaps for the reconstruction of dorsal digital defects achieved adequate coverage with minimal complications.…”

Reconstruction of soft tissue defects of hand: A systematic approach

“…4 Prolonged recovery in hand injuries can reduce the health related quality of life (HRQoL) in patients. 5,6 They can have significant impact on the rehabilitation and well-being of the patient in the long term. 7,8 Patients with other associated injuries, low socioeconomic class, female gender and people with suboptimal outcomes report a decrease in the quality of life.…”

“…7,8 Patients with other associated injuries, low socioeconomic class, female gender and people with suboptimal outcomes report a decrease in the quality of life. 5,9 Recent studies have shown that there is a decrease in the number of surgeons who would respond to the emergency department calls related to hand Reconstructive options given for each defect.…”