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Factors Associated with Unsuccessful Revascularization Surgery in Traumatic Upper-Extremity Amputation.

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Microsurgical revascularization for upper-extremity amputations is resource-intensive. Injury type, specifically avulsion or crush mechanisms and total amputations, significantly increases the risk of unsuccessful revascularization outcomes.

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Area of Science:

  • Orthopedic Surgery
  • Microsurgery
  • Trauma Surgery

Background:

  • Traumatic upper-extremity amputations present complex surgical challenges.
  • Microsurgical revascularization is a resource-intensive procedure.
  • Clinical decision-making requires understanding factors influencing revascularization success.

Purpose of the Study:

  • To identify prognostic factors associated with unsuccessful upper-extremity revascularization.
  • To inform clinical decision-making for traumatic amputation injuries.
  • To analyze the impact of injury details and patient characteristics on revascularization outcomes.

Main Methods:

  • Retrospective study of 282 patients undergoing upper-extremity revascularization (2009-2019).
  • Primary outcome: technical success (tissue survival) or failure.
  • Logistic regression analysis of prognostic factors: age, sex, smoking, diabetes, injury mechanism, tissue loss, amputation type.

Main Results:

  • Overall revascularization success rate was 76%.
  • Avulsion (aOR 5.9) and crush (aOR 2.8) injury mechanisms, and total amputation type (aOR 2.9) were associated with higher risk of failure.
  • Non-linear associations observed between age and tissue loss with unsuccessful revascularization; no association with sex, smoking, or diabetes.

Conclusions:

  • Injury characteristics are primary predictors of unsuccessful revascularization.
  • Total amputation type and avulsion/crush mechanisms significantly elevate failure risk.
  • Consider injury details in treatment decisions for upper-extremity amputations.