Functional Outcome after Successful Revascularisation and Replantation Surgery of the Fingers, Wrist, Forearm and Arm

Abstract

Introduction: Traumatic amputation (complete or partial) of a limb carries significant morbidity and disability. The primary aim of revascularisation and replant surgery is to restore functional outcome and not just to have a viable segment. Revascularisation and replant surgery has a higher success now with recent advances in microsurgery. Aim: To evaluate the long-term functional outcome of successful revascularisation and replantation surgery at the level of the fingers, wrists, forearms and arms. Materials and Methods: This was a retrospective study on 27 patients with partial or total amputation of the upper limb {digit(s), wrist, forearm and arm} who underwent revascularisation (n=18) or replantation (n=10) surgery. One patient had both revascularisation and replant surgery done. Partial amputation cases underwent revascularisation surgery and total amputation cases underwent replantation surgery. Objective variables noted were power grip, pinch grip, two-point discrimination, total active motion, Disability Assessment of Shoulder and Hand (DASH) scores, delay until operation and cold intolerance. Statistical analysis utilised was the Pearson linear correlation and the student t-test. Results: All 27 patients were males between 17-46-year-old (mean age of 27 years). The mean length of stay following revascularisation and replantation surgery was 11 days (range 4-20 days). The mean period of absence from work was 9.6 months (range 3-24 months). The mean time to surgical operation from the moment of trauma was eight hours and 30 minutes (range 4-12 hours). The mean result for two Point Discrimination (2PD) test was 8.03 mm (range 4-20 mm). Poorest function (highest DASH) was seen at transmetacarpal level of injury. Worst cold intolerance was seen at the wrist level of injury. Grip strength of the affected hand was 37.4% of the unaffected hand. Pinch grip of the affected hand was 74.4% of the unaffected hand. There was a positive correlation between the DASH score and delay to operation time (r=0.193) signifying poorer outcome (higher DASH score) with a delay to operation time. There was a negative correlation between DASH score and power of hand grip (r=-0.644, p<0.001) signifying a lower DASH score (i.e., better function) correlates to a stronger hand grip. On comparing DASH scores with cold intolerance, there was no significant difference. Conclusion: A longer duration from trauma to surgery significantly resulted in poorer functional outcome. Stronger grip strength significantly resulted in better functional outcome. Cold intolerance did not significantly affect functional outcome. Replantation or revascularisation surgery to attach a partial or total amputation remains a worthwhile endeavour as it shows a considerably good outcome.

Keywords

• amputation
• cold intolerance
• dash score
• microsurgery
• near total amputation