Recovery of function following replantation and revascularization of amputated hand parts

One hundred patients with replantation or revascularization of 149 hand units were studied with respect to return of function. Criteria for assessment included level and mechanism of injury, age, active range of motion, two-point discrimination sensibility ratings, grip and pinch strength, cold intolerance, and return to previous employment. Survival rate for replantation was 79% and for revascularization 97%. In the 38 replantation patients 80% underwent secondary operations, the most common being flexor tendon reconstruction. Most digits regained two-point discrimination of better than 10 mm; normal two-point discrimination was achieved in 40% of digits in this group; total active motion of 84% of fingers was rated poor. In the 62 revascularizations motion of 28% was rated poor, of 29% rated excellent. Restoration of tendon and joint function was aided by early and aggressive flexor tendon reconstruction and early digital motion; selected patients had primary insertion of silastic rods when there was expectation of a poor result due to tendon or soft-tissue damage. Isolated index amputations should not be replanted except in children or young adults. Revascularization should rarely be used when there is index tendon and bone involvement.