Assessment of hand function after successful replantation of upper limb at arm

Background Advances in microsurgery have improved the survival rate of arm replantation. However, the functional outcome of the replanted arms remains unpredictable. The authors performed a systematic review to evaluate the long-term outcome of arm replantation and the secondary reconstructive procedures after replantation. Methods All available English literature in the PubMed, Embase, and CENTRAL databases was searched for articles reporting functional outcome of successful arm replantation with follow-up period more than 1 yr. Clinical data were extracted including study characteristics, patient demographic information, functional outcome, and the numbers, types, and timing of secondary surgery. Among these, factors identified to influence overall outcome were reviewed and analyzed. Results Twenty-nine studies representing 79 arm replantations met the inclusion criteria. A total of 111 secondary procedures were recorded in 23 studies. The average number of secondary surgical procedures was 2.6 per patient. The most common procedures were nerve repair (23.4%), followed by functioning muscle transfer (19.8%), tendon transfer (17.1%), wound coverage (11.7%), contracture release (10.8%), bone repair (9.9%), arthrodesis (5.4%), and others (1.8%). Procedures involving wound coverage and nerve repair were mainly conducted in the early stage within 4 mos after replantation, whereas functioning muscle transfer, tendon transfer, and arthrodesis were mostly performed after 1 yr postoperatively. The satisfied (Chen I and II) functional outcome was achieved in 49.4% patients. The level of amputation and the type of injury have significant impact on final outcomes, whereas patients' age and timing of nerve repair do not. Patients with amputation at the distal third of the arms had a better outcome than those at the proximal and middle third of the arms (P < 0.05), and patients injured by sharp-cut recovered better than those by crush and avulsion (P < 0.05). Conclusions Optimal outcomes could be achieved in nearly half of patients with arm replantation, although multiple secondary surgical interventions and long periods of recovery are often required.

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Long-Term Outcomes of Arm Replantation

Wang¹,

Askari

Zhang

et al. 2020

Ann Plast Surg

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Evaluation of functional recovery after upper limb replantation

Tayah

2020

IqNJM

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Background: Although it is not possible always, reconstruction of defects with tissue such as defect in the original tissue usually results in best functions and esthetic outcomes. Therefore, replantation of an amputated part is superior to any other method of reconstruction mainly when the condition of the amputated part is good. The goal of replantation after amputation is function. Returning of circulation to an amputated part does not, by itself, mean success. Therefore, replantation that will not lead to a useful activity should be avoided. This is usually the case with severely crushed and extensively avulsed limbs. Objectives: evaluation of functions’ outcome after replantation. Patients and Methods: This study deals with 18 patients (14 males, 4 females) with different injuries. Severely crushed and extensively avulsed limbs have been excluded from repair. The level of injury involved an arm in two patients, an elbow in one, a forearm in two, a palm in two, a thumb in two, and fingers in nine. The patients’ age ranged between 2 and 55 years, during the period between January 2012 and February 2016. Results: In all the cases, replantation of the amputated part was successful; however, there were variations in functional recovery among the cases: in three cases, the functional recovery was very good, in five, it was good, in eight, it was fair, and in two, it was poor. Conclusions: Replantation should be tried for most amputation cases, as it has a superior aesthetic and functional result and serves a major psychological benefit for the patients. High success in a rat can be achieved when one chooses to replant an amputated part in good condition, all the structures are repaired at the time of the primary operation, and there exist excellent post-surgery physiotherapy and good patient compliance. Keywords: Replantation; amputation; vascular repair, limb trauma, revascularization, microsurgery.

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Assessment of hand function after successful replantation of upper limb at arm

Cited by 2 publications

References 6 publications

Long-Term Outcomes of Arm Replantation

Long-Term Outcomes of Arm Replantation

Evaluation of functional recovery after upper limb replantation

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