Functional Outcomes of Major Upper Extremity Replantation: A Scoping Review

Area of Science:

• Orthopedic Surgery
• Reconstructive Surgery
• Trauma Surgery

Background:

• Traumatic upper limb amputations proximal to the carpus are severe injuries with limited outcome data.
• Existing literature lacks comprehensive information on functional results and return to work after replantation.
• Understanding outcomes is crucial for patient counseling and surgical decision-making.

Purpose of the Study:

• To conduct a scoping review of outcomes following proximal to carpus replantation.
• To analyze functional outcomes, return to work rates, and secondary surgery requirements.
• To provide evidence-based insights for managing these complex injuries.

Main Methods:

• A systematic literature search was conducted across major databases (MEDLINE, EMBASE, Cochrane, CINAHL) following PRISMA guidelines.
• Included studies reported on functional outcomes, return to work, or secondary surgeries after traumatic proximal to carpus amputations.
• Data from 13 studies involving 136 major upper extremity replants were analyzed.

Main Results:

• Replantation outcomes varied by injury level; distal to elbow replants showed better functional scores (Chen's Criteria) than proximal to elbow.
• Return to work rates were higher for forearm (65%) and elbow (43%) replants compared to arm replants (32%).
• A mean of 2.4 secondary procedures were necessary per patient, indicating significant reconstructive needs.

Conclusions:

• Functional outcomes and return to work after major upper extremity replantation are strongly correlated with the level of amputation.
• Patient counseling should include realistic expectations regarding functional recovery, return to work, and the likelihood of requiring multiple secondary surgeries.
• This review offers valuable data to guide surgical planning and patient management for proximal upper limb replantations.