Long-term results of major upper extremity replantations

Objectives: The aim of this study was to evaluate long- term clinical and functional results of major upper extrem¬ity replantations. Methods: We retrospectively evaluated 26 male patients (mean age 27 years; range 3 to 69 years) who underwent ma¬jor upper extremity replantations and had a mean follow-up of 11.3 years (range 5 to 19 years). The levels of the replantations were transmetacarpal (n=6), wrist (n=4), forearm (n=5), elbow (n=4), and arm (n=7). Amputations were of clean-cut, crush, and avulsion types in seven, eight, and 11 patients, respec¬tively. Secondary operations were performed in 19 patients. Functional results were assessed using the Chenʹs criteria and the Turkish version of the DASH questionnaire (Disabilities of the Arm, Shoulder and Hand) was administered. Results: The mean surgical shortening was 37.2 mm, and the final mean radiographic shortening was 52.2 mm. The mean grip and pinch strengths on the affected side were 12.3 kg and 3.6 kg, compared to the strengths of 37.6 kg and 8.7 kg on the normal side, respectively. Monofilament testing showed sensory recovery in 20 patients. Two-point discrimination could be made by 18 patients for the me¬dian nerve, and by 17 patients for the ulnar nerve. Accord¬ing to the Chenʹs criteria, the results were very good or good in 17 patients (65.4%), moderate in three patients (11.5%), and poor in six patients (23.1%). Functional results were corre¬lated with the level (r=0.71) and type (r=0.65) of injury, with injuries at the elbow level and avulsion injuries being associ¬ated with a worse outcome. The mean DASH score was 6.7 (range 0 to 32.5) and the mean scores of Chenʹs grade I-II and grade III-IV patients differed significantly (p<0.05). Conclusion: Lower DASH scores show increased satisfac¬tion of the patients and improved use of their replanted ex¬tremities as the helper arm whereby functional deficiency is somewhat compensated.