Replantation and revascularization at the transmetacarpal level: long-term functional results

Thirteen consecutive transmetacarpal replantations and revascularizations in 12 patients were reviewed retrospectively. Ten patients (11 hands) sustained crush injuries, 1 withstood an explosive blast, and 1 suffered a guillotine amputation. Nine revascularizations (1 thumb and 31 fingers) and 4 replantations (1 thumb and 16 fingers), including bilateral procedures in 1 patient, were performed. Forty-four of 49 replantable digits (90%) were salvaged. Ten patients (11 hands) required secondary surgery (mean, 4.5 procedures per hand), 29 of 49 (60%) for tendon and joint scarring and 7 of 20 (14%) for nonunions or malunions. Range of motion averaged 109 degrees per digit. Intrinsic muscle function and pinch and grip strengths were weak or absent. Recovery of sensibility was poor. According to Chen et al.'s grading system of functional return, 4 (31%) were grade II, 4 (31%) were grade III, and 5 (38%) grade IV. The follow-up period ranged from 2.5 to 11 years. Only 1 patient resumed his prior occupation (as supervisor); 2 were permanently disabled, 3 pursued new and unrelated occupations, 2 were still in therapy, and 4 were lost to late follow-up evaluation. None of the manual laborers (11 patients) were able to return to their preinjury livelihood. Despite these discouragingly poor results, all patients were satisfied with the surgery.