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Complete major amputation of the upper extremity: Early results and initial treatment algorithm
Sven Märdian1, Björn D Krapohl, Jana Roffeis
1From the Center for Musculoskeletal Surgery, Charite Universitatsmedizin Berlin, Berlin, Germany.
The Journal of Trauma and Acute Care Surgery
|February 25, 2015
Summary
Successful replantation of major upper extremity amputations requires specialized trauma centers and a defined management algorithm. This approach ensures optimal surgical outcomes and lays the groundwork for future functional recovery.
Area of Science:
- Trauma surgery
- Orthopedic surgery
- Microsurgery
Background:
- Traumatic major upper extremity amputations significantly impair quality of life and incur socioeconomic costs.
- Effective initial management is crucial for successful limb replantation and functional restoration.
Purpose of the Study:
- To document the initial management of isolated traumatic major upper limb amputations from admission to soft tissue closure.
- To establish a distinct initial management algorithm for these severe injuries.
Main Methods:
- Data collection on patient and amputated part management in the emergency department.
- Recording of ischemia times, Injury Severity Score (ISS), surgical procedures, flap choice, and complication rates.
- Therapeutic study, level V evidence.
Main Results:
- All patients underwent successful replantation with an average total cold ischemia time of 203 minutes.
- Definitive soft tissue coverage was achieved within 23 days post-injury.
- Complications included two thromboembolic events and one early infection, all successfully managed.
Conclusions:
- Management of major upper extremity amputations necessitates specialized trauma centers with comprehensive resources.
- Adherence to a distinct treatment algorithm is essential for increasing successful replantation rates.
- Successful replantation provides a foundation for secondary reconstructive procedures and improved patient outcomes.