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

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.