Abstract
BackgroundReplantation in the upper extremity is a well-established microsurgical procedure. Many have reported patients’ satisfaction and functional measurements.The aim was to investigate the long time consequences as activity limitations in hand/arm, the general health and cold sensitivity after a replantation or revascularization in the upper extremity and to examine if sense of coherence (SOC) can be an indicator for rehabilitation focus.MethodsBetween 1994–2008, 326 patients needed replantation/revascularization in the upper extremity. 297 patients were followed up. Information was collected from the medical notes and by questionnaires [Quick-DASH (disability hand/arm), EuroQ-5D (general health), CISS (cold sensitivity) and SOC (sense of coherence)]. Severity of injury was classified with the modified Hand Injury Severity Score (MHISS).ResultsThe patients [272 (84%) men and 54 (16%) women; median age 39 years (1–81 years)], where most injuries affected fingers (63%) and thumb (25%), commonly affecting the proximal phalanx (43%). The injuries were commonly related to saws (22%), machines (20%) and wood splints (20%). A direct anastomosis (30%) or vein grafts (70%) were used. The overall survival was 90%. 59% were classified as Major.Equal parts of the injuries took part during work and leisure, DASH scores at follow up were worse (p = 0.005) in the former. Twenty percent changed work and 10% retired early. Patients with early retirement were significantly older, had a more severe injury, worse disability, quality of life and functional outcome. Median DASH score was low [11.4 (0–88.6)] and correlated with severity of injury. Abnormal cold sensitivity (CISS > 50) was seen in 51/209 (24%) and they had a worse disability, quality of life, functional outcome and lower SOC. Patients with a low SOC had on the whole a worse outcome compared to patients with a high SOC and with significant differences in age, EQ-5D, Quick-DASH and CISS.ConclusionsA high MHISS, abnormal cold intolerance and a low SOC seems to be factors influencing the patients’ outcome and might be relevant in the rehabilitation of the patients. Also, those who had to retire early had a worse disability, quality of life and functional outcome.
Highlights
Replantation in the upper extremity is a well-established microsurgical procedure
Many reports describe the outcome of digital replantation and reporting survival rates and functional outcome [2,3,4,5,6,7,8,9,10], including thumb replantation [11,12,13] and more proximal replantations, have been validated [14,15]
Patients with a low sense of coherence (SOC) had on the whole a worse outcome compared to patients with a high SOC
Summary
Replantation in the upper extremity is a well-established microsurgical procedure. Replantation and revascularization in the upper extremity after severe hand injury or total or subtotal amputation of fingers or, hand or arm is a well established microsurgical procedure [1]. Many reports describe the outcome of digital replantation and reporting survival rates and functional outcome [2,3,4,5,6,7,8,9,10], including thumb replantation [11,12,13] and more proximal replantations, have been validated [14,15]. The patient’s real benefit from a replantation is difficult to define. It may depend on how well the patient can cope with the trauma and be able to return to normal life of daily living, work and leisure activities
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