Replantation and revascularization of amputated upper limb appendages outcome and predicting the factors influencing the success rates of these procedures in a tertiary hospital: An 8-year retrospective, cross-sectional study

Kamarul, Tunku; Mansor, Azura; Robson, Noorzurani; Albusaidi, Salim Hh; Suhaeb, Abdulrazzaq M; Samsudin, Ely Zarina

doi:10.1177/2309499017749983

Cited by 17 publications

(18 citation statements)

References 46 publications

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“…According to our study, finger and thumb amputations and revascularization surgeries have better functional outcomes after secondary procedures then proximal-level injuries, with average scores of 29 (thumbs) and 33.5 (fingers). These results correspond to those from earlier research [30].…”

Section: Discussionsupporting

confidence: 93%

Functional Outcomes of Secondary Procedures in Upper Extremity Replantation and Revascularization

Khan

Rashid

et al. 2019

Cureus

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IntroductionTraumatic amputation of the upper limb has significant associated morbidities and disabilities. After successful replantation surgery, the micro-surgeons’ tasks are far from over. The replanted and revascularized segments have numerous functional restrictions and need various corrective secondary procedures. The aim of our study was to compare the functional results after secondary procedures by administering the Quick Disability of the Arm, Shoulder, and Hand (QuickDASH) questionnaire to patients who had successful upper limb replantation and revascularization.Materials and methodsThis prospective observational study involved 40 patients who had a partial or complete amputation of the upper limb and underwent secondary procedures to correct function after successful replantation and revascularization surgery. The patients’ functional outcomes after various secondary procedures were recorded using the QuickDASH questionnaire.ResultsThe mean QuickDASH score for thumb injuries was 42.3 pre-surgery but improved to 29.5 after secondary procedures, which was statistically significant (CI 11.12-14.87, p<0.01). The mean difference in the QuickDASH scores for finger injuries was also statistically significant: 45.5 preoperation and 33.7 postoperation (CI 9.89-13.70, p<0.01). For wrist injuries, the mean QuickDASH score was 52.8 presurgery and was 46.3 postoperatively (CI 1.81-6.58, p=0.0023). The QuickDASH scores of the patients with arm and forearm injuries showed no statistically significant improvement, with a preoperation score of 58.3 declining to 55.2 (p=0.98). The overall replantation and revascularization scores were 49.725 and 41.175 pre and postoperation, respectively (CI 8.35-8.75, p<0.01).ConclusionThe study finds that the level and mechanism of injury are important predictors of the functional outcomes of the replantation and revascularization of amputated upper-limb appendages. Most replanted and revascularized upper limbs have numerous functional limitations, and achieving good functional results requires one or more secondary procedures, whose type depends on various factors such as the injury type and mechanism. The QuickDASH results for functional outcomes before and after secondary procedures indicate that it is an easy-to-use, reliable, and effective measure of functional outcomes.

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Section: Discussionsupporting

confidence: 93%

Functional Outcomes of Secondary Procedures in Upper Extremity Replantation and Revascularization

Khan

Rashid

et al. 2019

Cureus

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“…Similar results were seen in the study by Kamarul et al, with mean MHQ scores for digit level injuries (thumb 67.6 and fingers 72.0) being higher than proximal injuries at the palm (50.0) or the wrist (52.8). 46 The DASH…”

Section: The Mhqmentioning

confidence: 99%

“…[2][3][4]15,51 Many experts have stated that ischemia time heavily influences the survival of replant and the long term functional outcomes. 2,3,46,51 In digit replantation consideration, Soucacos suggested a maximum of 8 hours for warm ischemia and 30 hours for cold ischemia. However, with advances in microsurgery, more recent studies have published non-inferior outcomes for cases with prolonged ischemia times.…”

Section: Factors Influencing Outcomes After Replantationmentioning

confidence: 99%