Replantation and revascularization at the transmetacarpal level: Long-term functional results

Weinzweig, Norman; Sharzer, Leonard A.; Starker, Isaac

doi:10.1016/s0363-5023(96)80208-5

Cited by 42 publications

(20 citation statements)

References 8 publications

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“…The secondary procedure rate found in this study is comparable to other studies. [18][19][20]22,[35][36][37][38][39] Various studies, however, often identify different frequencies of commonly performed secondary procedures. 17,22,39 Previous reports have cited tendon-related secondary procedures to be most common, whereas other studies have indicated bone/joint or soft tissue procedures to be most common.…”

Section: Discussionmentioning

confidence: 99%

Characteristics of Secondary Procedures following Digit and Hand Replantation

Shaterian

Sayadi

Anderson

et al. 2019

Journal of Hand and Microsurgery

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Introduction Secondary procedures following digit and hand replants are often necessary to optimize functional outcomes. To date, the incidence and characteristics of secondary procedures have yet to be fully defined. Materials and Methods A literature search was performed using the NCBI (National Center for Biotechnology Information) database for studies evaluating secondary procedures following digit and hand replantation/revascularization. Studies were evaluated for frequency and type of secondary procedure following replantation. Descriptive statistical analysis was conducted across the pooled dataset. Results Nineteen studies representing 1,485 replants were included in our analysis. A total of 1,124 secondary procedures were performed on the 1,485 replants. Secondary procedures most commonly addressed tendons (27.1%), bone/joints (16.1%), soft tissue coverage (15.4%), nerve (5.4%), and scar contractures (4.5%). A total of 12.7% of replants resulted in re-amputation (16.7% of secondary procedures). The details of secondary procedures are further described in the article. Conclusion Secondary procedures are often necessary following hand and digit replants. Patients should be informed of the possible need for subsequent surgery, including delayed amputation, to improve hand function. These data improve our understanding of replant outcomes and can help patients better comprehend the decision to undergo replantation.

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Section: Discussionmentioning

confidence: 99%

Characteristics of Secondary Procedures following Digit and Hand Replantation

Shaterian

Sayadi

Anderson

et al. 2019

Journal of Hand and Microsurgery

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“…Successful replantation or revascularisation of digits usually requires secondary procedures to improve their function. [ 4 7 8 9 ] To improve the function of salvaged fingers, our patient required secondary revascularisation, nerve reconstruction, joint reconstruction, two-stage flexor tendon reconstruction and skin revision. This algorithm followed a decision procedure, and our patient showed a notable functional improvement by reducing the DASH score 45 points from his initial score, which is three times the minimum reduction in the score that is required to identify patients whose condition has improved.…”

Section: Discussionmentioning

confidence: 99%

Algorithmic surgical enhancement of function after finger revascularisation

Landín

Bolado

Gajete

et al. 2016

Indian J Plast Surg

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Secondary surgical procedures can improve the function of revascularised and replanted digits. We describe the case of a patient who underwent multidigit revascularisation and replantation following a saw injury at flexor tendon Zone II. To achieve maximal functional improvement after finger revascularisation, we performed secondary surgical procedures in an order that was determined by following a reconstructive decision procedure that covered late revascularisation, nerve reconstruction, pedicled vascularised joint transfer, staged flexor tendon reconstruction and skin revision. Performing the procedures in this manner ensured overall safety. The patient's disabilities of the arm, hand and shoulder questionnaire score improved by 45 points, and the patient was able to return to work with an almost complete range of motion.

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“…For example, patients with replantation for zone III amputations (transmetacarpal amputations) typically have poor functional outcomes. (33) These amputations may have poor outcomes because of damage the lumbrical and interosseous muscles and disruption of blood flow to these structures. (34) Furthermore, for these injuries, the lumbrical and interosseous muscles are usually not repaired by surgeons.…”

Section: Clinical Relevancementioning

confidence: 99%

A Biomechanical and Evolutionary Perspective on the Function of the Lumbrical Muscle

Wang

McGlinn

Chung

2014

The Journal of Hand Surgery

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The lumbrical muscles of the hand originate from the flexor digitorum profundus tendons and insert onto the lateral band of the extensor tendons. Owing to these movable attachments, the function of this muscle is difficult to visualize. To better determine the function of this muscle, we took a novel approach by considering its relative anatomy, biomechanical characteristics, and evolution. With the smallest physiological cross-sectional area in the upper extremity, the lumbrical muscles have weak motor function, which is only 1/10 of the interosseous muscle. Because it is spindle-rich, the lumbrical muscles play an important role in the sensory feedback of the distal interphalangeal, proximal interphalangeal and metacarpalphalangeal joints of the fingers. The first two lumbrical muscles have lower variation in anatomy and higher density of muscle spindles compared to the ulnar two lumbricals. Additionally, the index and long finger lumbrical muscles are innervated by the median nerve, which also innervates the thenar muscles of the thumb. Therefore, it is possible that the first two lumbricals are functionally more important than the two ulnar lumbricals, specifically for precision pinch movements.

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Replantation and revascularization at the transmetacarpal level: Long-term functional results

Cited by 42 publications

References 8 publications

Characteristics of Secondary Procedures following Digit and Hand Replantation

Characteristics of Secondary Procedures following Digit and Hand Replantation

Algorithmic surgical enhancement of function after finger revascularisation

A Biomechanical and Evolutionary Perspective on the Function of the Lumbrical Muscle

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