Macroreplantation: An overview

Kleinert, James M.; Graham, Brent

doi:10.1002/micr.1920110309

Cited by 11 publications

(10 citation statements)

References 24 publications

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“…16 Factors that must be considered include the predicted morbidity for the patient, the expected chance of survival of the thumb and functional outcome of the replanted part, and the total cost incurred by the patient or third party payer. 3 Comparison of functional results between previously published series is always difficult due to existing differences in the patient population, type of traumatic amputation, parts replanted, and in the methods of evaluation applied.…”

Section: Discussionmentioning

confidence: 99%

Long-term functional and subjective results of thumb replantation

et al. 2006

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The aim of this follow-up study was to evaluate the functional and subjective results after thumb replantation. Twenty-four patients with replantation of the thumb, performed during the period 1992-1997, were reexamined after 6.5 years (range, 4.2-9.1 years post-injury). In 10 cases the amputations were isolated, 14 amputations were combined with other injuries of the hand, 15 amputations resulted from crush/avulsion injuries, and 9 amputations were sharp. Range of motion, grip strength, cutaneous sensibility, and upper-extremity functioning using the DASH questionnaire were determined. A correlation analysis with important variables was performed. Average range-of-motion in the metacarpophalangeal joint was 44 degrees (+/-24.2) and in the interphalangeal joint was 12 degrees (+/-8.4). Grip-strength of the injured hand was 70% (+/-31.4) and pinch strength was 68% (+/-28.7) in comparison to the non-injured hand. DASH-scores correlated with grip-strength, pinch-strength, and cutaneous sensation but no correlation was found between DASH and the level of amputation. Functional results were independent of amputation levels and patient age. Although the results of cutaneous sensibility were only moderate, patients were able to use their thumb to perform work and daily living activities. The majority of patients had returned to their previous occupation.

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Section: Discussionmentioning

confidence: 99%

Long-term functional and subjective results of thumb replantation

et al. 2006

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“…Vessel damage from crush injury significantly limits the efficacy of revascularization of the digit. 1,3 Despite resection of the segments most severely injured as visualized microscopically, thrombosis rates are predictably higher in revascularized digits that underwent crush or avulsion injury prior to reanastamosis. The etiology of this increased thrombogenesis potential in the grossly normal vessel is poorly understood.…”

Section: Discussionmentioning

confidence: 99%

“…Thrombosis of digital vessels at the anastomosis site following replantation due to a crush injury remains a significant problem in microsurgery. [1][2][3][4] Disruption of digital vessels secondary to a crushing mechanism is related to significantly lower anastomotic success rates than those for uncrushed vessels. [1][2][3] Despite adequate resection of damaged vessels and either primary anastomosis of the remaining vessels or use of vein grafts, thrombosis continues to occur frequently in vessels that have undergone crush or avulsion injuries.…”

Section: Abstract: Vascular Spasm Crush Injury Microsurgerymentioning

confidence: 99%

Pathophysiological Process of Traumatic Vascular Spasm in Multiple Crush Injury

Yan

Rowe²,

Dzwierzynski³

et al. 2007

J reconstr Microsurg

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Despite recent advances in microsurgery, the incidence of thrombosis of repaired digital vessels following crush injury is higher than that of uncrushed arteries. The purpose of this study was to evaluate the effects of traumatic crush injury on uncrushed segments of artery adjacent to crushed segments. Sprague-Dawley rat-tail arteries were crushed for 1 hour by 30 pounds of force at two separate 3-mm-wide segments, with 10 mm of uncrushed artery between segments. Luminal size of the uncrushed segments decreased progressively over the first 12 hours, with a significant reduction by 4 hours postcrush. The condition of the arteries continued to deteriorate until, by 24 hours postinjury, they had been denuded of endothelium, and smooth muscle damage had occurred. Untreated vasospasm following a multiple-level crush injury therefore results in progressive endothelial and intimal damage and thrombosis in the intervening healthy uncrushed segments of artery. This article discusses the implications of these findings.

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“…A meticulous history from witnesses should be obtained. 4 The limb should be handled as gently as possible. Ideally only one doctor should touch the limb to avoid crushing or contamination of any tissue.…”

Section: Amputated Limb: Preoperative Managementmentioning

confidence: 99%