Hand Function After Replantation or Revascularization of Upper Extremity Injuries:A Follow-Up Study of 21 Cases Operated on 1979–1985 in Göteborg

Abstract

Twenty-one patients with revascularized/replanted amputated parts of the upper limb were studied for an evaluation of hand function. Two patients had been injured at the lower arm to wrist level, four between the wrist and MCP joint, three distal to the MCP joints in thumbs and/or fingers, and twelve in the thumb only. Hand function was measured as grip and pinch strength, range of movement (ROM), sensibility (two point discrimination), and Sollerman test score. Cold sensitivity as related to circulatory changes in the replanted limb was evaluated in six patients using the critical opening test (COP). Twelve of 17 initiated replantations (71%), and 11 of 12 revascularizations (92%), were successful. Hand function was restricted in patients with amputations at the lower arm to wrist level, fair in replanted midhands, good, but with wide variations after replantations at the MCP or distal II-V fingers, and best of all in replanted thumbs. Sensibility was poor in a majority of the patients. Three out of six of the patients who were COP-tested had significantly reduced blood pressure in the replanted part. The test results (grip, ROM, Sollerman score) in three patients with amputated thumbs were not found to differ greatly from those with replanted thumbs. These results raise the question of whether the Sollerman test underestimates the importance of the thumb or whether the thumb is overestimated in hand function.

Long Term Follow-Up After Finger Replantation

“…This was noted by Blomgren et al (1998), who obtained the best functional results after replantation of thumbs, although the active range of motion of replanted/revascularised thumbs in this study was only 19% of the active range of motion of the contralateral thumbs. Urbaniak et al (1985) reported an average active range of motion of 351 (13% of the contralateral digit) after single digit replantation at the level proximally to the FDS insertion and a mean active range of motion of 821 (30% of the contralateral digit) after replantation distal to FDS insertion.…”

Hand injury from powered wood splitters

“…The Sollerman test has been used to evaluate hand function in tetraplegia, gout, and after hand trauma. [12,18,51] It has a good intra-and inter rater reliability when used in patients with chronic stroke. [13] Aims To describe the epidemiology of hand injury from powered wood splitters.…”

Functional results of 46 thumb replantations and revascularisations

“…Traumatic amputation of a thumb is an absolute indication for replantation since the functional and aesthetic results of a successfully replanted thumb are better than those obtained by other available Many systems for evaluation of hand function after replantation of digits have been proposed. 3- 6 Burton stated that any system of evaluation for reattachment surgery must be multifactorial .7 Evaluation of late results and comparing different series after replantation of multiple digits often combined with other injuries on the ipsilateral or contralateral side is difficult. This series of 46 patients with isolated thumb replantation presented here is rather more uniform than usual.…”