Long-term follow-up after finger and upper-limb replantation: clinical, angiologic, and lymphographic studies.

Abstract

This 10-year follow-up study evaluates 25 patients with a total of 57 successfully replanted fingers and six successfully replanted upper limbs. The global functional loss, including loss of range of motion, sensibility, and strength of the hand, was determined using the "Millesi score." The hemodynamic parameters of replanted and control fingers under resting and stress conditions were measured using a laser Doppler flowmeter. The lymphatic system at the site of replantation was examined by fluorescence microlymphography. All patients showed a considerable functional loss, according to the Millesi score, that averaged 56 percent of the normal function of the hand. In order to overcome functional deficit, many patients had developed successful compensatory mechanisms. In general, the patients themselves subjectively rated their functional deficits lower than indicated by the Millesi score. Laser Doppler flowmetry at rest and after arterial occlusion, and capillaroscopy before, during, and after a cold provocation test, revealed subnormal resting flow conditions and significantly decreased vascular capacity in the replanted fingers. Lymphatic drainage capacity was also significantly reduced despite documented reanastomosis between the skin microlymphatic network distal and proximal to the scar (fluorescence microlymphography). The coexistence of functional loss with compensatory mechanisms, decreased reactive hyperemia, and deficit in lymphatic drainage, present in all patients, must be considered as definitive sequelae of the initial injury.