Long-term results of major upper extremity replantations

Abstract

We analyzed the long-term functional outcome in patients with major upper extremity replantations. Two patients had amputations proximal to the elbow joint, two had elbow disarticulations and five patients had amputations at the forearm. The mean age was 24 and the mean follow-up time was 18 years. Six patients have undergone secondary operations. The mean grip strength was restored to 34% of the contralateral extremity. Protective sensation was restored in all patients. According to Chen's functional recovery scale, five patients had excellent, two had good, and two had fair results. Grip strength, two-point discrimination, ranges of motion and Chen's scale did not improve after 5 years. However, Semmes-Weinstein monofilament testing and cold intolerance continued to improve up to 10 and 12 years, respectively. Replantation of an upper extremity proximal to the wrist joint satisfactorily restored the upper extremity function.

Long-Term Outcomes of Major Upper Extremity Replantations

“…Our patient population tended to be slightly older (mean age 45 years) than the age reported in literature (24 to 36 years) (4,9,(27)(28)(29). It has been reported that patients may be less likely to undergo replantation if they are self-pay, older age and at nonteaching hospitals (27).…”

“…It has been reported to be between 80% and 94% (3,4). However, this outcome measure only indicates that the replanted limb is viable at the follow-up visit.…”

“…Given that major upper extremity replantations have been performed and reported for more than three decades (4)(5)(6), it is surprising that these outcomes have never been measured using patient-reported outcome measures.…”

“…However, this outcome measure only indicates that the replanted limb is viable at the follow-up visit. More useful outcome measures are those assessing the functional outcome of the surgery such as Chen's criteria, the ability to resume work, range of motion relative to normal, sensibility and power (4). Ideal assessments are those that include patient-reported quality of life as well as functional outcomes.…”

Macroreplantations of the upper extremity: a series of 11 patients

“…However, there are only a few reports about traumatic complete amputations proximal to the wrist [8]. In 1990, our center reported its 10-year experience in severe complex injuries of the upper extremity [9].…”