Which instrument should we use to assess hand function after digital replantation?

Kamburoğlu, Haldun Onuralp; Aksu, Ali̇ Emre; Sönmez, Emine; Isci, Evren; Şafak, Tunç; Keçik, Abdullah

doi:10.1177/1753193410396648

Cited by 5 publications

(9 citation statements)

References 12 publications

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“…DASH or Quick-DASH have been used in other replantation studies and reported values are the same as in this study [2,13]. However, other reported higher DASH scores, which might reflect different follow up times and different patient selection [11,42]. …”

Section: Discussionsupporting

confidence: 50%

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Disability and health after replantation or revascularisation in the upper extremity in a population in southern Sweden – a retrospective long time follow up

Rosberg

2014

BMC Musculoskelet Disord

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Background: Replantation in the upper extremity is a well-established microsurgical procedure. Many have reported patients' satisfaction and functional measurements. The aim was to investigate the long time consequences as activity limitations in hand/arm, the general health and cold sensitivity after a replantation or revascularization in the upper extremity and to examine if sense of coherence (SOC) can be an indicator for rehabilitation focus. Methods: Between 1994-2008, 326 patients needed replantation/revascularization in the upper extremity. 297 patients were followed up. Information was collected from the medical notes and by questionnaires [Quick-DASH (disability hand/arm), EuroQ-5D (general health), CISS (cold sensitivity) and SOC (sense of coherence)]. Severity of injury was classified with the modified Hand Injury Severity Score (MHISS).Results: The patients [272 (84%) men and 54 (16%) women; median age 39 years (1-81 years)], where most injuries affected fingers (63%) and thumb (25%), commonly affecting the proximal phalanx (43%). The injuries were commonly related to saws (22%), machines (20%) and wood splints (20%). A direct anastomosis (30%) or vein grafts (70%) were used. The overall survival was 90%. 59% were classified as Major. Equal parts of the injuries took part during work and leisure, DASH scores at follow up were worse (p = 0.005) in the former. Twenty percent changed work and 10% retired early. Patients with early retirement were significantly older, had a more severe injury, worse disability, quality of life and functional outcome. Median DASH score was low [11.4 (0-88.6)] and correlated with severity of injury. Abnormal cold sensitivity (CISS > 50) was seen in 51/209 (24%) and they had a worse disability, quality of life, functional outcome and lower SOC. Patients with a low SOC had on the whole a worse outcome compared to patients with a high SOC and with significant differences in age, EQ-5D, Quick-DASH and CISS.Conclusions: A high MHISS, abnormal cold intolerance and a low SOC seems to be factors influencing the patients' outcome and might be relevant in the rehabilitation of the patients. Also, those who had to retire early had a worse disability, quality of life and functional outcome.

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Section: Discussionsupporting

confidence: 50%

“…However, the EQ-5D has not before been used in this patient group. Hand function has been evaluated previously by different types of scores [2,8,11,13,14,42]. Quality of life is more than hand function.…”

Section: Discussionmentioning

confidence: 99%

Disability and health after replantation or revascularisation in the upper extremity in a population in southern Sweden – a retrospective long time follow up

Rosberg

2014

BMC Musculoskelet Disord

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“…This scoring method relies on the surgeon’s assessment of the patient’s use of the limb, based on 4 objective criteria: sensation, range of motion, Medical Research Council (MRC) power grade, and global use of the affected extremity. 15 , 16 Replantations are then rated as grade I (excellent), grade II (good), grade III (fair), and grade IV (poor). A summary of the Chen criteria can be found in Table 3 .…”

Section: Resultsmentioning

confidence: 99%

“…The TAMAI score involves the measurement of joint range of motion, ability to perform activities of daily living, subjective symptoms, patient overall satisfaction, and job status. 16 , 17 Of the 11 cases graded using the TAMAI scoring, 1 patient had a poor outcome (9%), 5 with a fair outcome (45%), and 5 more with a good outcome (45%). 14 …”

Section: Resultsmentioning

confidence: 99%

Functional Outcomes of Major Upper Extremity Replantation: A Scoping Review

Ramji

Steve

Premji

et al. 2020

Plastic and Reconstructive Surgery - Global Open

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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.

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“…Although the Chen functional grade has not been validated, it is used widely to evaluate results after hand replantation. However, it was not our main outcome measure because a good correlation between the DASH score and the Chen functional grade is yet to be determined after replantation [56]. The mean HTSS values indicated the results for the allograft and patient function to be good.…”

Section: Discussionmentioning

confidence: 99%

Outcomes with respect to disabilities of the upper limb after hand allograft transplantation: a systematic review

Landín

Bonastre

Díez

et al. 2012

Transplant International

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Summary The aim of this work is to compare disabilities of the upper limb before and after hand allograft transplantation (HAT), and to describe the side effects of immunosuppressive (IS) agents given to recipients of hand allografts. Clinical cases of HAT published between 1999 and 2011 in English, French, or German were reviewed systematically, with emphasis on comparing disabilities of the arm, shoulder and hand (DASH) scores before and after transplantation. Duration of ischemia, extent of amputation, and time since amputation were evaluated for their effect on intrinsic musculature function. Infectious, metabolic, and oncological complications because of IS therapy were recorded. Twenty‐eight patients were reported in 56 clinical manuscripts. Among these patients, disabilities of the upper limb dropped by a mean of 27.6 (±19.04) points on the DASH score after HAT (P = 0.005). Lower DASH scores (P = 0.036) were recorded after secondary surgery on hand allografts. The presence of intrinsic muscle function was observed in 57% of the recipients. Duration of ischemia, extent of transplantation, and time since amputation were not associated statistically with the return of intrinsic musculature function. Three grafts were lost to follow‐up because of noncompliance with immunosuppression, rejection, and arterial thrombosis, respectively. Fifty‐two complications caused by IS agents were reported, and they were successfully managed medically or surgically. HAT recipients showed notable functional gains, but most complications resulted from the IS protocols.

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Which instrument should we use to assess hand function after digital replantation?

Cited by 5 publications

References 12 publications

Disability and health after replantation or revascularisation in the upper extremity in a population in southern Sweden – a retrospective long time follow up

Disability and health after replantation or revascularisation in the upper extremity in a population in southern Sweden – a retrospective long time follow up

Functional Outcomes of Major Upper Extremity Replantation: A Scoping Review

Outcomes with respect to disabilities of the upper limb after hand allograft transplantation: a systematic review

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