Elsevier

The Journal of Hand Surgery

Volume 23, Issue 5, September 1998, Pages 783-791
The Journal of Hand Surgery

Major replantation versus revision amputation and prosthetic fitting in the upper extremity: A late functional outcomes study*

https://doi.org/10.1016/S0363-5023(98)80151-2Get rights and content

The functional outcomes of amputated arms that were either replanted or had a prosthesis were compared. In addition, factors that influenced the functional outcome of replants were evaluated. The Carroll test was used to evaluate functional capacity of 22 successful upper extremity replantations at or proximal to the wrist as well as 22 amputees (at similar levels) fitted with a variety of prosthetic devices. The outcome was excellent or good in 8 (36%) replanted limbs. This proportion was statistically higher than those grades in the prosthetic group. When the groups were more closely matched (adults with below elbow injuries), the replantation group had 6 (50%) good or excellent outcomes and the prosthetic group had none. An analysis of covariance of the replatations demonstrated a statistical association between a better outcome in younger patients with more distal injuries. This study indicates that replantation produces superior functional results compared with amputation and a prosthesis.

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    In major proximal crush avulsion amputations of the upper limb, it is the policy of the unit to go in for replantation, if the hand is structurally intact or can be made functional. This is made on the premise that a well reconstructed hand is functionally more useful than the best available prosthesis [6]. Unacceptable long ischemia time, technical impossibility and associated co morbid conditions which would put the patient's general condition to undue risk are the contraindications [4].

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*

No benefits in any form have been received or will be received from a commercial party related directly or indirectly to the subjects of this article.

1

From the Divisions of Orthopaedic and Plastic Surgery, University of Toronto, Toronto, Ontario; the Kleinert, Kutz and Associates Hand Care Center, Louisville, KY; the Department of Surgery, University of Louisville, Louisville, KY; the Christine M. Kleinert Institute for Hand and Microsurgery, and the Departments of Physiology and Biophysics and Surgery, University of Louisville, Louisville, KY.

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