[An assessment of the results of upper limb replantation]

During the period 1996-2005, in General and Hand Surgery Department in Szczecin, 47 patients, 45 males and 2 females, with a me an age of 42 years, with total (72%) and subtotal (28%) amputations within the metacarpus and more proximal were operated. 35 replants survived, however 10 (21%) necrotized, in 2 cases (5%) blood flow was not re-established during the operations. The study presents results of assessment of objective parameters of 19 patients who received replantation of amputated extremities at the level of metacarpus - 5 cases, wrist - 9, forearm - 3, elbow - 1 and arm - 1 case. Patients were followed-up at mean of 2.5 years after injury (range 6 months -10 years). The average active range of motion of fingers in replanted extremities was 116 degrees (range 26-224 degrees). The average total grip strength was 8.3 kG (range 2-12 kG). The subjective assessment of hand dexterity with DASH questionnaire was mean of 103 points, (range 72-148). Range of motion was satisfactory in most of metacarpals and wrist replantations and less pleasing in forearm and arm amputations. Simultaneously better objective results were achieved in metacarpals and wrist replantations (14 cases, mean DASH 98), than forearm and arm replantations (5 cases, mean DASH 117). The Semmes-Weinstein monofilament testing revealed feeling of light touch good in 2 cases, satisfactory in 4 cases (median nerve) and in 2 cases (ulnar nerve). Only protective sensation in 8 cases (median nerve) and 10 cases (ulnar nerve). In Chen's classification 3 patients were scored I grade, 2 patients II grade and 9 patients III grade. The patients underwent 78 corrective operations (mean 2.3 per patinet, range 1-5) in order to improve function or cover skin defect. The results support an opinion that these time consuming operations result in salvage of functionally acceptable extremity what advocates that in every case of major amputation, regardless the mechanism or extend of injury an attempt of replantation should be considered, when patient's general health condition is stable.