Late outcomes after hand replantation

Abstract

ABSTRACT

Introduction: The objective of this study was to evaluate functional outcomes in patients who underwent successful replantation of amputated hands at least 5 years ago in Department of General and Hand Surgery of the Pomeranian Medical University in Szczecin (Poland).

Materials and methods: 54 patients who underwent successful replantation of amputated hands or fingers were identified. These patients were mailed a set of questionnaires asking for hand function (DASH questionnaire), quality of life (SF-36), cold intolerance, and return to work. 22 completed questionnaires were returned (41% response rate), and these data were the subject of the analysis. The study group also comprised 5 patients who were examined in the hospital. The group consisted of 22 patients, 20 men and 2 women, with a mean age of 43 years (range 20–82), who had hand or finger replantation a mean of 6.5 years before the assessment (range 5–7). Most patients had amputation of the metacarpus (n = 9), followed by fingers II–V (n = 8), wrist (n = 2), thumb (n = 2) and forearm (n = 1). The cause of amputation was circular saw in 15 cases (68%) followed by industrial or agriculture machinery.

Results: The mean DASH score for the whole group was 23 (range 2–74), indicating on average mild dysfunction of the replanted hands. Ten (45%) patients regained very good function (DASH <20), 7 (32%) showed mild dysfunction (DASH 21–40), and 5 had greater disability (DASH >40). The functional outcomes were best in patients following wrist and thumb replantation (DASH 4), less favourable in patients after finger II–V replantation (DASH 16), and poorest in patients after metacarpus and forearm replantation (DASH 33). The mean score in the physical subscale of the SF-36 questionnaire was 61, indicating good quality of life. For the mental SF-36 subscale the mean score was 58, indicating moderate quality of life. Twenty patients complained of troublesome symptoms of cold intolerance. Twelve (54%) patients returned to previously performed work.

Conclusion: The results of this study show that most patients regained good function of replanted hands, allowing them good functioning in a daily life and a return to work in some
of them.