Long-Term Outcomes of Arm Replantation

Abstract

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.

Corrective Tendon Repair with Local Anesthesia following Wrist-level Replantation

“…Wrist-level replantation has the most favorable outcomes among major limb replantation surgeries, which rely on important basic principles, including immediate aggressive debridement, rigid bone fixation, limited warm ischemia, and sequential soft tissue reconstruction. 2 , 3 However, in wrist-level replantation, few studies have addressed tendon repair issues with particular reference to the final hand function and requirement of secondary procedures. Some surgeons only repaired the FDP tendons and routinely resected the FDS tendons to avoid future adhesions, and total active motion could be achieved to 50%–70% in Mahajan’s study and 70%–80% in Hoang’s study.…”