Replantation and revascularization of large segments of the hand and forearm

From November 1985 to July 1989, the authors performed replantation or revascularization surgery on 18 patients in whom a large segment of the upper limb between the elbow and the palm of the hand had been either completely severed (9 cases) or incompletely severed with ischemia (9 cases). The operation was successful in 16 cases, and the authors were able to clinically review 14 patients (average follow-up, 23 months). The results were analyzed using a protocol based on the following parameters: range of motion, sensation, muscle strength, cold intolerance, pain, return to work, cosmesis, and the patient's level of satisfaction. The final outcome was rated excellent in 2 cases, good in 6 cases, fair in 3 cases, and poor in 3 cases. The authors point out that recovery of sensory and motor function in replantation of large portions of the hand and forearm is often difficult. Nevertheless, the good cosmetic result, the lack of pain, and the high probability of returning to work made the patients quite satisfied with this kind of reconstructive surgery.