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Wijk U, Björkman A, Carlsson IK, Kristjansdottir F, Mrkonjic A, Rosén B, Antfolk C. A BIONIC HAND VS. A REPLANTED HAND. JOURNAL OF REHABILITATION MEDICINE. CLINICAL COMMUNICATIONS 2024; 7:24854. [PMID: 38274357 PMCID: PMC10810139 DOI: 10.2340/jrmcc.v7.24854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/11/2023] [Accepted: 12/14/2023] [Indexed: 01/27/2024]
Abstract
Objective Evaluation of the hand function affected when replacing a malfunctioning hand by a bionic hand. Design Case report. Subjects One individual that wished for a better quality of life after unsatisfying hand function following a replantation. Methods A quantitative and qualitative evaluation of body functions as well as activity performance and participation before and after a planned amputation and prosthetic fitting is presented. Results Improvements were seen in the patient-reported outcome measures (PROMs) that were used regarding activity (Disability of the Arm, Shoulder and Hand [DASH] and Canadian Occupational Performance Measure [COPM]), pain (Neuropathic Pain Symptom Inventory [NPSI], Brief Pain Inventory [BPI], Visual Analogue Scale [VAS]), cold intolerance (CISS) and health related quality of life (SF-36), as well as in the standardised grip function test, Southampton Hand Assessment Procedure (SHAP). No referred sensations were seen but the discriminative touch on the forearm was improved. In the qualitative interview, a relief of pain, a lack of cold intolerance, improved appearance, better grip function and overall emotional wellbeing were expressed. Conclusions The planned amputation and subsequent fitting and usage of a hand prosthesis were satisfying for the individual with positive effects on activity and participation. Clinical relevance When the hand function after a hand replantation does not reach satisfactory levels, a planned amputation and a prosthetic hand can be the right solution.
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Affiliation(s)
- Ulrika Wijk
- Department of Translational Medicine - Hand Surgery, Lund University, Skåne University Hospital, Malmö, Sweden
| | - Anders Björkman
- Department of Hand Surgery, Institute of Clinical Sciences, Sahlgrenska University Hospital, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Ingela K Carlsson
- Department of Translational Medicine - Hand Surgery, Lund University, Skåne University Hospital, Malmö, Sweden
| | - Freyja Kristjansdottir
- Department of Translational Medicine - Hand Surgery, Lund University, Skåne University Hospital, Malmö, Sweden
| | - Ante Mrkonjic
- Department of Translational Medicine - Hand Surgery, Lund University, Skåne University Hospital, Malmö, Sweden
| | - Birgitta Rosén
- Department of Translational Medicine - Hand Surgery, Lund University, Skåne University Hospital, Malmö, Sweden
| | - Christian Antfolk
- Deptartment of Biomedical Engineering, Faculty of Engineering, Lund University, Lund, Sweden
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Iamaguchi RB, Dias GM, Iwase FDOC, Rezende MRDE, Mattar R. CAN TEMPORARY ARTERY CATHETERIZATION EXTEND LIMITS OF ISCHEMIA TIME FOR MACROREPLANTATION? ACTA ORTOPEDICA BRASILEIRA 2023; 31:e267476. [PMID: 38115877 PMCID: PMC10726705 DOI: 10.1590/1413-785220233105e267476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Accepted: 05/19/2023] [Indexed: 12/21/2023]
Abstract
We observe delayed referrals to appropriate Microsurgery Unit and definitive treatment of traumatic limb amputations. Cases with wrist proximal amputations have a deadline for surgical replantation as these configure life-threatening injuries. Objective To analyze patients with traumatic proximal wrist upper limb amputations with prolonged ischemic time who underwent temporary artery catheterization to assess stump viability and results. Methods A case-series study including all patients with a proximal wrist upper limb amputation and a cold ischemic time equal to or above six hours from 2017 to 2021. Results In total, two surgeons operated eight patients who had experienced forearm amputation injuries. Median ischemia time totaled eight hours. All patients required additional surgeries, most commonly split-thickness skin graft or fixation revision (three patients). This study obtained five successful macroreimplantations. The mean cold ischemia time was longer in the group with successful macroreimplantations (7.4 hours) than of the unsuccessful group (9 hours). Conclusion Macroreplantations require immediate referral to microsurgery and, although temporary artery catheterization helps surgical decision making, the technique seems to fail to influence outcomes. Level of Evidence IV, Retrospective Case Series.
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Affiliation(s)
- Raquel Bernardelli Iamaguchi
- Universidade de Sao Paulo, Faculdade de Medicina, Hospital das Clinicas, Instituto de Ortopedia e Traumatologia IOT HCFMUSP, Grupo de Cirurgia da Mao e Microcirurgia Reconstrutiva, Sao Paulo, SP, Brazil
| | - Guilherme Moreira Dias
- Universidade de Sao Paulo, Faculdade de Medicina, Hospital das Clinicas, Instituto de Ortopedia e Traumatologia IOT HCFMUSP, Grupo de Cirurgia da Mao e Microcirurgia Reconstrutiva, Sao Paulo, SP, Brazil
| | - Fernanda DO Carmo Iwase
- Universidade de Sao Paulo, Faculdade de Medicina, Hospital das Clinicas, Instituto de Ortopedia e Traumatologia IOT HCFMUSP, Grupo de Cirurgia da Mao e Microcirurgia Reconstrutiva, Sao Paulo, SP, Brazil
| | - Marcelo Rosa DE Rezende
- Universidade de Sao Paulo, Faculdade de Medicina, Hospital das Clinicas, Instituto de Ortopedia e Traumatologia IOT HCFMUSP, Grupo de Cirurgia da Mao e Microcirurgia Reconstrutiva, Sao Paulo, SP, Brazil
| | - Rames Mattar
- Universidade de Sao Paulo, Faculdade de Medicina, Hospital das Clinicas, Instituto de Ortopedia e Traumatologia IOT HCFMUSP, Grupo de Cirurgia da Mao e Microcirurgia Reconstrutiva, Sao Paulo, SP, Brazil
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Pyörny J, Karelson M, Sletten IN, Ukkola A, Jokihaara J. Patient-reported significant disability after major traumatic upper extremity amputation. J Hand Surg Eur Vol 2023:17531934231215791. [PMID: 37994012 DOI: 10.1177/17531934231215791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2023]
Abstract
The aims of this study were to record patient-reported outcomes of treatment of proximal upper extremity amputation injuries and subsequent return to work. A consecutive cohort of 38 patients with a traumatic amputation at or proximal to the carpus had been treated with a replantation or revision (completion) amputation in Tampere University Hospital between 2009 and 2019, and 31 of them participated in this study. The primary outcome was the Disabilities of the Arm, Shoulder and Hand Outcome Measure (DASH). Patients reported significant disability indicated by DASH score after replantation (median 30; interquartile range [IQR] 21-47) and revision (completion) amputation (median 33; IQR 16-52). Most patients had cold intolerance and reported low hand function and aesthetics scores. Out of 17 working patients, 10 did not return to their previous work. Our study demonstrates the influence of major upper extremity amputation on daily life activities, even after a successful replantation.Level of evidence: IV.
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Affiliation(s)
- Joonas Pyörny
- Faculty of Medicine and Health Technology, Tampere University, Finland
| | - Margit Karelson
- Center for Musculoskeletal Diseases, Tampere University Hospital, Tampere, Finland
| | | | - Anniina Ukkola
- Center for Musculoskeletal Diseases, Tampere University Hospital, Tampere, Finland
| | - Jarkko Jokihaara
- Faculty of Medicine and Health Technology, Tampere University, Finland
- Center for Musculoskeletal Diseases, Tampere University Hospital, Tampere, Finland
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4
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DeFoor MT, Micallef CJ, Lybeck DO, Wilson DJ, Plucknette BF, Sabbag CM. Free Functional Muscle Transfer and One Bone Forearm for Upper-Extremity Limb Salvage After High-Energy Ballistic Trauma. JOURNAL OF HAND SURGERY GLOBAL ONLINE 2023; 5:701-706. [PMID: 37790815 PMCID: PMC10543809 DOI: 10.1016/j.jhsg.2023.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 06/10/2023] [Indexed: 10/05/2023] Open
Abstract
Upper-extremity limb salvage following high-energy trauma poses unique challenges of massive soft tissue injury in the setting of large bone defects, traumatic segmental neurovascular injuries, and functional deficits. These complex injuries require multidisciplinary care to achieve requisite revascularization, bone stabilization, and preservation of remaining options for soft tissue coverage. This case presents a 45-year-old man who sustained a high-velocity gunshot resulting in a dysvascular limb. Through shared decision-making, upper-extremity limb salvage was pursued. Successful initial limb salvage included a reversed great saphenous vein graft from the brachial artery to the radial artery, followed by one bone forearm with nonvascularized graft from the ipsilateral distal ulna, latissimus dorsi free functioning muscle transfer with an end-to-side anastomosis to the brachial artery proximal to the vein graft, and coaptation of the anterior interosseous donor nerve from the proximal median nerve stump to the thoracodorsal recipient nerve.
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Affiliation(s)
- Mikalyn T. DeFoor
- Department of Orthopaedic Surgery, San Antonio Military Medical Center, San Antonio, TX
| | | | - Dustin O. Lybeck
- Department of Orthopaedic Surgery, San Antonio Military Medical Center, San Antonio, TX
| | - David J. Wilson
- Department of Orthopaedic Surgery, San Antonio Military Medical Center, San Antonio, TX
| | | | - Casey M. Sabbag
- Department of Orthopaedic Surgery, San Antonio Military Medical Center, San Antonio, TX
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5
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Murphy NJ, Balogh ZJ. Transfixation of the elbow joint for upper limb salvage. ANZ J Surg 2023; 93:1441-1442. [PMID: 36809557 DOI: 10.1111/ans.18291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Accepted: 01/08/2023] [Indexed: 02/23/2023]
Affiliation(s)
- Nicholas J Murphy
- Department of Traumatology, John Hunter Hospital & University of Newcastle, Newcastle, New South Wales, Australia
| | - Zsolt J Balogh
- Department of Traumatology, John Hunter Hospital & University of Newcastle, Newcastle, New South Wales, Australia
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Sabapathy SR, Venkatramani H, Dheenadhayalan J, Bhardwaj P, Zhang D, Rajasekaran S. Forequarter Replantation. J Hand Surg Am 2022; 47:1123.e1-1123.e5. [PMID: 34561134 DOI: 10.1016/j.jhsa.2021.07.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Revised: 05/06/2021] [Accepted: 07/16/2021] [Indexed: 02/02/2023]
Abstract
Traumatic forequarter amputations are rare injuries in which the arm, clavicle, scapula, and proximal shoulder muscles are avulsed from the body. Historically, forequarter amputation has been treated with hemorrhage control, wound debridement, and soft tissue coverage. To our knowledge, successful forequarter replantation has not been previously reported. We present a rare case of forequarter amputation treated successfully with replantation. At the 4.5-year follow-up after replantation, the patient had antigravity elbow flexion, modest shoulder elevation, modest extrinsic finger function, and crude sensation. We discuss relevant technical considerations that indicate that, despite challenges, forequarter replantation can be achieved with success.
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Affiliation(s)
- S Raja Sabapathy
- Department of Plastic, Hand and Reconstructive Microsurgery, Ganga Hospital, Coimbatore, Tamil Nadu, India.
| | - Hari Venkatramani
- Department of Plastic, Hand and Reconstructive Microsurgery, Ganga Hospital, Coimbatore, Tamil Nadu, India
| | - J Dheenadhayalan
- Department of Orthopaedic Surgery, Ganga Hospital, Coimbatore, Tamil Nadu, India
| | - Praveen Bhardwaj
- Department of Plastic, Hand and Reconstructive Microsurgery, Ganga Hospital, Coimbatore, Tamil Nadu, India
| | - Dafang Zhang
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, MA
| | - S Rajasekaran
- Department of Orthopaedic Surgery, Ganga Hospital, Coimbatore, Tamil Nadu, India
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7
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Ding W, Li X, Chen H, Wang X, Zhou D, Wang X. Nerve merging repair in the replantation of a severed limb with defects in multiple nerves: five cases and long-term follow-up. BMC Surg 2022; 22:222. [PMID: 35681188 PMCID: PMC9185902 DOI: 10.1186/s12893-022-01673-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Accepted: 05/31/2022] [Indexed: 11/10/2022] Open
Abstract
Background Repairing all nerves is challenging in cases of upper arm avulsion combined with defects in multiple nerves because the donor area for autogenous nerve transplantation is limited and the outcomes of long-segment allogeneic nerve transplantation are poor. Based on the principle of magnified nerve regeneration, we present a method called nerve merging repair, the feasibility of which needs to be confirmed in clinical practice. Methods The nerve merging repair method relies on the use of fewer proximal nerves to innervate more distal nerves and depends mainly on whether the radial nerve (RN) can repair itself. In the case of defects in multiple nerves precluding RN self-repair, median-(median + radial) (M-(M + R)) repair is performed. If the RN can undergo self-repair, median-(median + ulnar) (M-(M + U)) or ulnar-(ulnar + median) (U-(U + M)) is used to repair the three nerves. Five cases were included in the study and involved the analysis of joint motor function, muscle strength and sensory recovery of the affected limb. Results The replanted limb survived in all 5 cases. Follow-up visits were conducted with the patients for 51–80 months, during which they experienced satisfactory recovery of skin sensation, elbow flexion and extension and partial recovery of hand muscle strength. Conclusions To a certain extent, treatment with the nerve merging repair method improved the sensory and motor function of the affected limb and limited the loss of function of the donor nerve area. This intervention provides a new approach for repairing long-segment defects in multiple nerves caused by avulsion amputation of the upper limb.
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Affiliation(s)
- Wenquan Ding
- Department of Hand Surgery, Department of Plastic Reconstructive Surgery, Ningbo No. 6 Hospital, 315040, Ningbo, China
| | - Xueyuan Li
- Department of Hand Surgery, Department of Plastic Reconstructive Surgery, Ningbo No. 6 Hospital, 315040, Ningbo, China
| | - Hong Chen
- Department of Hand Surgery, Department of Plastic Reconstructive Surgery, Ningbo No. 6 Hospital, 315040, Ningbo, China
| | - Xiaofeng Wang
- Department of Hand Surgery, Department of Plastic Reconstructive Surgery, Ningbo No. 6 Hospital, 315040, Ningbo, China
| | - Danya Zhou
- Department of Hand Surgery, Department of Plastic Reconstructive Surgery, Ningbo No. 6 Hospital, 315040, Ningbo, China
| | - Xin Wang
- Department of Hand Surgery, Department of Plastic Reconstructive Surgery, Ningbo No. 6 Hospital, 315040, Ningbo, China.
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Wells MW, Rampazzo A, Papay F, Gharb BB. Two Decades of Hand Transplantation: A Systematic Review of Outcomes. Ann Plast Surg 2022; 88:335-344. [PMID: 35113506 DOI: 10.1097/sap.0000000000003056] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT Hand transplantation for upper extremity amputation provides a unique treatment that restores form and function, which may not be achieved by traditional reconstruction and prosthetics. However, despite enhancing quality of life, hand transplantation remains controversial, because of immunological complications, transplant rejection, and medication effects. This systematic literature review sought to collect information on current experiences and outcomes of hand transplants to determine the efficacy and utility of hand transplants. The databases PubMed, Scopus, and Embase were analyzed with combinations of "hand" or "upper extremity" or "arm" and "transplant" or "allograft," with information collected on recipient characteristics, details of transplant, immunological outcomes, functional outcomes, and complications. Functional outcomes, as measured by Disabilities of Arm, Shoulder and Hand score, were compared between patient groups using Wilcoxon signed-rank test or 1-way analysis of variance test and post hoc Tukey test. Within the 108 articles that fulfilled inclusion and exclusion criteria, there were 96 patients with 148 hand transplants. There were 57 patients who experienced acute rejection and 5 patients with chronic rejection. Disabilities of the Arm, Shoulder and Hand scores significantly decreased after hand transplantation and were significantly lower for distal transplants compared with proximal transplants. There were 3 patients with concurrent face transplantation and 2 patients with simultaneous leg transplants. Sixteen patients experienced amputation of the hand transplant, and there were 5 deaths. This study found that hand transplantation provides significant restoration of function and form, especially for proximal transplants. Reduction in complications, such as rejection and amputation, can be achieved by decreasing medication cost and patient education.
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Affiliation(s)
- Michael W Wells
- From the Case Western Reserve University, School of Medicine
| | | | - Francis Papay
- Department of Plastic Surgery, Cleveland Clinic, Cleveland, OH
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Figueroa BA, Said SA, Ordenana C, Rezaei M, Orfahli LM, Dubé GP, Papay F, Brunengraber H, Dasarathy S, Rampazzo A, Gharb BB. Ex vivo normothermic preservation of amputated limbs with a hemoglobin-based oxygen carrier perfusate. J Trauma Acute Care Surg 2022; 92:388-397. [PMID: 34510075 DOI: 10.1097/ta.0000000000003395] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Ex vivo normothermic limb perfusion (EVNLP) preserves amputated limbs under near-physiologic conditions. Perfusates containing red blood cells (RBCs) have shown to improve outcomes during ex vivo normothermic organ perfusion, when compared with acellular perfusates. To avoid limitations associated with the use of blood-based products, we evaluated the feasibility of EVNLP using a polymerized hemoglobin-based oxygen carrier-201 (HBOC-201). METHODS Twenty-four porcine forelimbs were procured from Yorkshire pigs. Six forelimbs underwent EVNLP with an HBOC-201-based perfusate, six with an RBC-based perfusate, and 12 served as static cold storage (SCS) controls. Ex vivo normothermic limb perfusion was terminated in the presence of systolic arterial pressure of 115 mm Hg or greater, fullness of compartments, or drop of tissue oxygen saturation by 20%. Limb contractility, weight change, compartment pressure, tissue oxygen saturation, oxygen uptake rates (OURs) were assessed. Perfusate fluid-dynamics, gases, electrolytes, metabolites, methemoglobin, creatine kinase, and myoglobin concentration were measured. Uniformity of skin perfusion was assessed with indocyanine green angiography and infrared thermography. RESULTS Warm ischemia time before EVNLP was 35.50 ± 8.62 minutes (HBOC-201), 30.17 ± 8.03 minutes (RBC) and 37.82 ± 10.45 (SCS) (p = 0.09). Ex vivo normothermic limb perfusion duration was 22.5 ± 1.7 hours (HBOC-201) and 28.2 ± 7.3 hours (RBC) (p = 0.04). Vascular flow (325 ± 25 mL·min-1 vs. 444.7 ± 50.6 mL·min-1; p = 0.39), OUR (2.0 ± 1.45 mL O2·min-1·g-1 vs. 1.3 ± 0.92 mL O2·min-1·g-1 of tissue; p = 0.80), lactate (14.66 ± 4.26 mmol·L-1 vs. 13.11 ± 6.68 mmol·L-1; p = 0.32), perfusate pH (7.53 ± 0.25 HBOC-201; 7.50 ± 0.23 RBC; p = 0.82), flexor (28.3 ± 22.0 vs. 27.5 ± 10.6; p = 0.99), and extensor (31.5 ± 22.9 vs. 28.8 ± 14.5; p = 0.82) compartment pressures, and weight changes (23.1 ± 3.0% vs. 13.2 ± 22.7; p = 0.07) were not significantly different between HBOC-201 and RBC groups, respectively. In HBOC-201 perfused limbs, methemoglobin levels increased, reaching 47.8 ± 12.1% at endpoint. Methemoglobin saturation did not affect OUR (ρ = -0.15, r2 = 0.022; p = 0.45). A significantly greater number of necrotic myocytes was found in the SCS group at endpoint (SCS, 127 ± 17 cells; HBOC-201, 72 ± 30 cells; RBC-based, 56 ± 40 cells; vs. p = 0.003). CONCLUSION HBOC-201- and RBC-based perfusates similarly support isolated limb physiology, metabolism, and function.
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Affiliation(s)
- Brian A Figueroa
- From the Department of Plastic Surgery (B.A.F., S.A.S., C.O., M.R., L.M.O., F.P., A.R., B.B.G.), Cleveland Clinic; Department of Nutrition (H.B.), School of Medicine, Case Western Reserve University; Department of Gastroenterology (S.D.), Cleveland Clinic, Cleveland, Ohio; and Hemoglobin Oxygen Therapeutics, LLC (G.P.D.), Souderton, Pennsylvania
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Frey S, Motawar B, Buchanan K, Kaufman C, Stevens P, Cirstea C, Morrow S. Greater and More Natural Use of the Upper Limbs During Everyday Life by Former Amputees Versus Prosthesis Users. Neurorehabil Neural Repair 2022; 36:227-238. [PMID: 34996313 DOI: 10.1177/15459683211062889] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Hand loss profoundly impacts daily functioning. Reversal of amputation through hand replantation or transplantation offers an alternative to prosthetics for some. Whether recipients exhibit more extensive and natural limb use during everyday life than prosthesis users is, however, unknown.We asked unilateral, below-elbow amputees (N = 22), hand graft recipients (transplants N = 4; replants N = 2), and healthy matched controls (N = 20) to wear wireless accelerometers distally on their forearms/prostheses and proximally on their upper arms. These units captured limb activity over 3 days within participants' natural environments.Graft recipients exhibited heavier reliance on their affected hands compared to amputees' reliance on their prostheses, P < .001. Likewise, reliance on the injured side upper arm was also greater for hand graft recipients than amputees, regardless of whether they were wearing their prostheses, P < .05 in both cases. Hand graft recipients, like healthy controls, also relied more on forearm vs upper arm movements when controlling their limbs, P < .001.Compared with conventional prosthesis users, graft recipients exhibited more extensive and natural functioning of the upper limbs during everyday activities. This information is an important addition to other considerations when evaluating risk-benefit of these treatment alternatives.
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Affiliation(s)
- Scott Frey
- Dept. of Psychological Sciences, 14716University of Missouri, Columbia, MO, USA.,Dept. of Physical Medicine and Rehabilitation, 14716University of Missouri, Columbia, MO, USA.,Dept. of Cardiovascular and Thoracic Surgery, 12254University of Louisville School of Medicine, Louisville, KY, USA
| | - Binal Motawar
- Dept. of Physical Medicine and Rehabilitation, 14716University of Missouri, Columbia, MO, USA
| | - Kelli Buchanan
- Dept. of Physical Medicine and Rehabilitation, 14716University of Missouri, Columbia, MO, USA
| | - Christina Kaufman
- Dept. of Cardiovascular and Thoracic Surgery, 12254University of Louisville School of Medicine, Louisville, KY, USA
| | | | - Carmen Cirstea
- Dept. of Physical Medicine and Rehabilitation, 14716University of Missouri, Columbia, MO, USA
| | - Sean Morrow
- Dept. of Psychological Sciences, 14716University of Missouri, Columbia, MO, USA
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12
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Abstract
For those patients with partial hand level amputation who would benefit from myoelectric prosthetic digits for enhanced prehensile function, the Starfish Procedure provides muscle transfers, which allow for the generation of intuitively controlled electromyographic signals for individual digital control with minimal myoelectric cross-talk. Thoughtful preoperative planning allows for creation of multiple sources of high-quality myoelectric signal in a single operation, which does not require microsurgery, providing for wide applicability to hand surgeons of all backgrounds.
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Affiliation(s)
| | - Bryan J Loeffler
- Reconstructive Center for Lost Limbs, OrthoCarolina Hand Center, 1915 Randolph Road, Charlotte, NC 28207, USA; Department of Orthopaedic Surgery, Atrium Healthcare, Charlotte, NC, USA
| | - Raymond Glenn Gaston
- Reconstructive Center for Lost Limbs, OrthoCarolina Hand Center, 1915 Randolph Road, Charlotte, NC 28207, USA; Department of Orthopaedic Surgery, Atrium Healthcare, Charlotte, NC, USA.
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13
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Nayar SK, Alcock HMF, Edwards DS. Primary amputation versus limb salvage in upper limb major trauma: a systematic review. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2021; 32:395-403. [PMID: 34050819 PMCID: PMC8924095 DOI: 10.1007/s00590-021-03008-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 05/11/2021] [Indexed: 11/03/2022]
Abstract
PURPOSE Severe upper limb injuries can result in devastating consequences to functional and psychological well-being. Primary objectives of this review were to evaluate indications for amputation versus limb salvage in upper limb major trauma and whether any existing scoring systems can aid in decision-making. Secondary objectives were to assess the functional and psychological outcomes from amputation versus limb salvage. METHODS A systematic review was carried out in accordance with PRISMA guidelines. A search strategy was conducted on the MEDLINE, EMBASE, and Cochrane databases. Quality was assessed using the ROBINS-I tool. The review protocol was registered in PROSPERO. RESULTS A total of 15 studies met inclusion criteria, encompassing 6113 patients. 141 underwent primary amputation and 5972 limb salvage. General indications for amputation included at least two of the following: uncontrollable haemodynamic instability; extensive and concurrent soft tissue, bone, vascular and/or nerve injuries; prolonged limb ischaemia; and blunt arterial trauma or crush injury. The Mangled Extremity Severity Score alone does not accurately predict need for amputation, however, the Mangled Extremity Syndrome Index may be a more precise tool. Comparable patient-reported functional and psychological outcomes are seen between the two treatment modalities. CONCLUSIONS Decision regarding amputation versus limb salvage of the upper limb is multifactorial. Current scoring systems are predominantly based on lower limb trauma, with lack of robust evidence to guide management of the upper extremity. Further high-quality studies are required to validate scoring systems which may aid in decision-making and provide further information on the outcomes from the two treatment options.
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Affiliation(s)
- Sandeep Krishan Nayar
- Centre for Trauma Sciences, Blizard Institute, Queen Mary University of London, 4 Newark Street, London, E1 2AT, UK.
| | - Harry M F Alcock
- Centre for Trauma Sciences, Blizard Institute, Queen Mary University of London, 4 Newark Street, London, E1 2AT, UK
| | - Dafydd S Edwards
- Centre for Trauma Sciences, Blizard Institute, Queen Mary University of London, 4 Newark Street, London, E1 2AT, UK
- Department of Trauma and Orthopaedics, Barts Health NHS Trust, London, UK
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14
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Özkan Ö, Özkan Ö, Uysal H, Leblebicioğlu G, Tombak K, Ogan O, Göztepe MB. Replantation of forequarter amputation: Report of two cases with successful structural, motor and sensorial results. Microsurgery 2021; 41:562-568. [PMID: 33864654 DOI: 10.1002/micr.30739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 01/31/2021] [Accepted: 02/18/2021] [Indexed: 11/07/2022]
Abstract
Although there have been numerous reports of major replantation of upper extremity amputations, limited numbers of above-elbow amputation replantation have been reported. We present the technical details of two successful replantations of forequarter amputations in a nine-year-old girl and a three-year-old boy. In both cases, the forequarter was amputated due to avulsion traction injuries resulting in amputation including the entire upper limb, while the integrity of the scapula and parascapular muscles was maintained, with no injury to the glenohumeral joint. Replantation was performed, involving a shorter ischemia time with proper fixation, and vascular and neural repairs. Postoperative recovery was uneventful, and motor and sensorial acquisition were quite satisfactory during follow-up periods of 9 and 6 years, respectively. Proper fixation of the amputated part mimicking the original anatomy, radical debridement of avulsed vessels, and reconstruction of the defect using long vein grafts and neural repair while maintaining proper integrity are the most important factors in success. When the requirements are met, replantation of the forequarter in a child yields a superior outcome, from both the functional and esthetic perspectives. To the best of our knowledge, this is the first report in the English literature involving two sequential cases of such high-level replantation resulting in successful reacquisition of both viability and function.
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Affiliation(s)
- Ömer Özkan
- Department of Plastic and Reconstructive Surgery, Akdeniz University Faculty of Medicine, Antalya, Turkey
| | - Özlenen Özkan
- Department of Plastic and Reconstructive Surgery, Akdeniz University Faculty of Medicine, Antalya, Turkey
| | - Hilmi Uysal
- Department of Neurology, Akdeniz University Faculty of Medicine, Antalya, Turkey
| | | | - Kadriye Tombak
- Department of Physical Medicine and Rehabilitation, Akdeniz University Faculty of Medicine, Antalya, Turkey
| | - Onur Ogan
- Department of Plastic and Reconstructive Surgery, Akdeniz University Faculty of Medicine, Antalya, Turkey
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15
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Ramji M, Steve AK, Premji Z, Yeung J. Functional Outcomes of Major Upper Extremity Replantation: A Scoping Review. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2020; 8:e3071. [PMID: 33173661 PMCID: PMC7647661 DOI: 10.1097/gox.0000000000003071] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 07/06/2020] [Indexed: 11/30/2022]
Abstract
Traumatic upper limb amputations proximal to the carpus are devastating injuries. Existing literature on outcomes following replantation is limited. Our objective was to perform a scoping review of (1) functional outcomes; (2) return to work data; and (3) secondary surgeries required following proximal to carpus replantation.
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Affiliation(s)
- Maleka Ramji
- Section of Plastic Surgery, Department of Surgery, University of Calgary
| | - Anna K Steve
- Section of Plastic Surgery, Department of Surgery, University of Calgary
| | - Zahra Premji
- Libraries and Cultural Resources, University of Calgary
| | - Justin Yeung
- Section of Plastic Surgery, Department of Surgery, University of Calgary
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16
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Naalla R, Singhal M, Dawar R, Maurya M. Salvage forearm to arm replantation. BMJ Case Rep 2020; 13:13/9/e236637. [PMID: 32878838 DOI: 10.1136/bcr-2020-236637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Ravikiran Naalla
- Plastic Reconstructive and Burns Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Maneesh Singhal
- Plastic Reconstructive and Burns Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Rakesh Dawar
- Plastic Reconstructive and Burns Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Manish Maurya
- Plastic Reconstructive and Burns Surgery, All India Institute of Medical Sciences, New Delhi, India
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17
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Bates TJ, Fergason JR, Pierrie SN. Technological Advances in Prosthesis Design and Rehabilitation Following Upper Extremity Limb Loss. Curr Rev Musculoskelet Med 2020; 13:485-493. [PMID: 32488625 PMCID: PMC7340716 DOI: 10.1007/s12178-020-09656-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
PURPOSE OF REVIEW The complexity of the human extremity, particularly the upper extremity and the hand, allows us to interact with the world. Prosthetists have struggled to recreate the intuitive motor control, light touch sensation, and proprioception of the innate limb in a manner that reflects the complexity of its native form and function. Nevertheless, recent advances in prosthesis technology, surgical innovations, and enhanced rehabilitation appear promising for patients with limb loss who hope to return to their pre-injury level of function. The purpose of this review is to illustrate recent technological advances that are moving us one step closer to the goal of multi-functional, self-identifiable, durable, and intuitive prostheses. RECENT FINDINGS Surgical advances such as targeted muscle reinnervation, regenerative peripheral nerve interfaces, agonist-antagonist myoneural interfaces, and targeted sensory reinnervation; development of technology designed to restore sensation, such as implanted sensors and haptic devices; and evolution of osseointegrated (bone-anchored) prostheses show great promise. Augmented and virtual reality platforms have the potential to enhance prosthesis design, pre-prosthetic training, incorporation, and use. Emerging technologies move surgeons, rehabilitation physicians, therapists, and prosthetists closer to the goal of creating highly functional prostheses with elevated sensory and motor control. Collaboration between medical teams, scientists, and industry stakeholders will be required to keep pace with patients who require durable, high-functioning prostheses.
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Affiliation(s)
- Taylor J Bates
- Department of Orthopaedics, San Antonio Military Medical Center, 3551 Roger Brooke Drive, JBSA-Ft Sam Houston, TX, 78234, USA
| | - John R Fergason
- Center for the Intrepid, San Antonio Military Medical Center, Fort Sam Houston, JBSA-Ft Sam Houston, TX, USA
| | - Sarah N Pierrie
- Department of Orthopaedics, San Antonio Military Medical Center, 3551 Roger Brooke Drive, JBSA-Ft Sam Houston, TX, 78234, USA.
- Center for the Intrepid, San Antonio Military Medical Center, Fort Sam Houston, JBSA-Ft Sam Houston, TX, USA.
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18
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Pyörny J, Huttunen TT, Mattila VM, Jokihaara J. Upper extremity replantation and revascularization in Finland between 1998 and 2016. J Plast Surg Hand Surg 2020; 54:297-301. [PMID: 32498580 DOI: 10.1080/2000656x.2020.1771720] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Emergency replantation and revascularization operations of upper extremity injuries demand considerable resources, but their actual occurrence is unknown. This study evaluated all emergency replantations and revascularizations in the upper extremity in Finland from 1998 to 2016. A total of 2,434 operations were identified within the study period. The average number of operations per year was 128 which corresponds with 2.4 operations per 100,000 person years. Operations were most common in persons aged 20 to 59 years and the rate of operations ranged from 1.4 to 5.0 per 100,000 person years. Thirteen percent of the patients were women and 87% were men. This study shows rates of emergency replantation and revascularization operations in upper extremity injuries and proves that the rates have been constant over the past 19 years in Finland.
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Affiliation(s)
- Joonas Pyörny
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Tuomas T Huttunen
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.,Department of Emergency, Anesthesia and Pain Medicine, Tampere University Hospital, Tampere, Finland.,The Division of Orthopedics and Biotechnology, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden
| | - Ville M Mattila
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.,COXA Hospital for Joint Replacement, Tampere, Finland.,Department of Orthopedics and Traumatology, Tampere University Hospital, Tampere, Finland
| | - Jarkko Jokihaara
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.,Department of Hand and Microsurgery, Tampere University Hospital, Tampere, Finland
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19
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Abstract
BACKGROUND Advances in microsurgery have improved the survival rate of arm replantation. However, the functional outcome of the replanted arms remains unpredictable. The authors performed a systematic review to evaluate the long-term outcome of arm replantation and the secondary reconstructive procedures after replantation. METHODS All available English literature in the PubMed, Embase, and CENTRAL databases was searched for articles reporting functional outcome of successful arm replantation with follow-up period more than 1 yr. Clinical data were extracted including study characteristics, patient demographic information, functional outcome, and the numbers, types, and timing of secondary surgery. Among these, factors identified to influence overall outcome were reviewed and analyzed. RESULTS Twenty-nine studies representing 79 arm replantations met the inclusion criteria. A total of 111 secondary procedures were recorded in 23 studies. The average number of secondary surgical procedures was 2.6 per patient. The most common procedures were nerve repair (23.4%), followed by functioning muscle transfer (19.8%), tendon transfer (17.1%), wound coverage (11.7%), contracture release (10.8%), bone repair (9.9%), arthrodesis (5.4%), and others (1.8%). Procedures involving wound coverage and nerve repair were mainly conducted in the early stage within 4 mos after replantation, whereas functioning muscle transfer, tendon transfer, and arthrodesis were mostly performed after 1 yr postoperatively. The satisfied (Chen I and II) functional outcome was achieved in 49.4% patients. The level of amputation and the type of injury have significant impact on final outcomes, whereas patients' age and timing of nerve repair do not. Patients with amputation at the distal third of the arms had a better outcome than those at the proximal and middle third of the arms (P < 0.05), and patients injured by sharp-cut recovered better than those by crush and avulsion (P < 0.05). CONCLUSIONS Optimal outcomes could be achieved in nearly half of patients with arm replantation, although multiple secondary surgical interventions and long periods of recovery are often required.
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20
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Rezaei M, Rampazzo A, Bassiri Gharb B. Machine preservation of extremities. Artif Organs 2019; 44:361-366. [DOI: 10.1111/aor.13615] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Accepted: 11/29/2019] [Indexed: 12/21/2022]
Affiliation(s)
- Majid Rezaei
- Department of Plastic Surgery Cleveland Clinic Cleveland Ohio
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21
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Marques E, Maiorino EJ, Tallackson Z, Masoomi H. Self-amputation of the Upper Extremity: A Case Report and Review of the Literature. Cureus 2019; 11:e5858. [PMID: 31763081 PMCID: PMC6834103 DOI: 10.7759/cureus.5858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Indications for upper-extremity replantation include wrist-level and wrist-proximal amputations, due to the devastating loss of function incurred from these severe injuries. Decisions regarding replantation must be made expeditiously at these proximal levels in an effort to minimize ischemia time. This decision-making process becomes more complicated when a patient presents following intentional self-amputation of an extremity, especially in the setting of an associated mood disorder, psychiatric illness, and/or frank psychosis. A case report is presented involving a 28-year-old right-hand dominant male with untreated depression and recent suicidal ideation who sustained a complete left forearm amputation (distal-third forearm-level) from a self-inflicted circular saw injury. We conducted a PubMed literature search of other reported cases of intentional self-amputations of the hand and upper extremity. The patient underwent replantation of the left upper extremity. At six years postoperatively, the patient was extremely satisfied with the appearance and function of the replanted extremity. Dash score was 5.8 with a Chen Grade 1 (excellent) functional recovery. A literature search identified 16 cases of self-inflicted upper extremity amputation. One patient died at the scene. 87% (13/15) of patients presenting to the hospital were diagnosed with a psychiatric disorder (depression n = 6, bipolar n = 2, and schizophrenia n = 5). 67% (10/15) of these patients were also diagnosed with psychosis. Ten patients underwent replantation (nine at hand/wrist level and one at forearm level), all of which were viable postoperatively. Detailed functional outcome data were not reported in any of the cases. Four patients (40%) were pleased or satisfied with the outcome, but subjective outcomes were not reported for the other six patients. Intentional self-amputation of the hand/upper extremity is an extreme and uncommon act, often presenting with complex psychiatric issues. Although replantation is technically feasible in this patient population, long-term subjective and objective functional outcomes are largely unknown. Future study of this unique group of patients is needed to better assess patient-reported outcomes and functional outcomes of replantation, which could help guide decision making at the time of initial injury.
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Affiliation(s)
- Erik Marques
- Plastic and Reconstructive Surgery, University of Texas Health Science Center, Houston, USA
| | - Eric J Maiorino
- Plastic and Reconstructive Surgery, University of Texas Health Science Center, Houston, USA
| | - Zachary Tallackson
- Plastic and Reconstructive Surgery, University of Texas Health Science Center, Houston, USA
| | - Hossein Masoomi
- Plastic and Reconstructive Surgery, University of Texas Health Science Center, Houston, USA
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22
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Mitchell SL, Hayda R, Chen AT, Carlini AR, Ficke JR, MacKenzie EJ. The Military Extremity Trauma Amputation/Limb Salvage (METALS) Study: Outcomes of Amputation Compared with Limb Salvage Following Major Upper-Extremity Trauma. J Bone Joint Surg Am 2019; 101:1470-1478. [PMID: 31436655 PMCID: PMC7406140 DOI: 10.2106/jbjs.18.00970] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Severe upper-extremity injuries account for almost one-half of all extremity trauma in recent conflicts in the Global War on Terror. Few long-term outcomes studies address severe combat-related upper-extremity injuries. This study's objective was to describe long-term functional outcomes of amputation compared with those of limb salvage in Global War on Terror veterans who sustained severe upper-extremity injuries. Limb salvage was hypothesized to result in better arm and hand function scores, overall functional status, and quality of life, with similar pain interference. METHODS This retrospective cohort study utilized data from the Military Extremity Trauma Amputation/Limb Salvage (METALS) study for a subset of 155 individuals who sustained major upper-extremity injuries treated with amputation or limb salvage. Participants were interviewed by telephone 40 months after injury, assessing social support, personal habits, and patient-reported outcome instruments for function, activity, depression, pain, and posttraumatic stress. Outcomes were evaluated for participants with severe upper-extremity injuries and were compared with participants with concomitant severe, lower-extremity injury. The analysis of outcomes comparing limb salvage with amputation was restricted to the 137 participants with a unilateral upper-extremity injury because of the small number of patients with bilateral upper-extremity injuries (n = 18). RESULTS Overall, participants with upper-extremity injuries reported moderate to high levels of physical and psychosocial disability. Short Musculoskeletal Function Assessment (SMFA) scores were high across domains; 19.4% screened positive for posttraumatic stress disorder (PTSD), and 12.3% were positive for depression. Nonetheless, 63.6% of participants were working, were on active duty, or were attending school, and 38.7% of participants were involved in vigorous recreational activities. No significant differences in outcomes were observed between patients who underwent limb salvage and those who underwent amputation. CONCLUSIONS Severe, combat-related upper-extremity injuries result in diminished self-reported function and psychosocial health. Our results suggest that long-term outcomes are equivalent for those treated with amputation or limb salvage. Addressing or preventing PTSD, depression, chronic pain, and associated health habits may result in less disability burden in this population. LEVEL OF EVIDENCE Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Stuart L. Mitchell
- Department of Orthopaedic Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland,Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Roman Hayda
- Department of Orthopaedic Surgery, Brown University Warren Alpert School of Medicine, Providence, Rhode Island
| | - Andrew T. Chen
- Department of Orthopaedic Surgery, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Anthony R. Carlini
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - James R. Ficke
- Department of Orthopaedic Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Ellen J. MacKenzie
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
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23
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Mahendru S, Khazanchi RK, Brajesh V, Jawed A, Aggarwal A, Singh H, Singh S, Krishnan S. Replantation in scapulothoracic avulsion amputation of the right upper limb in a 3-year-old child- A preliminary report. Indian J Plast Surg 2019; 49:279-282. [PMID: 27833298 PMCID: PMC5053008 DOI: 10.4103/0970-0358.191308] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
Replantations for major amputations of upper extremity have been widely performed. We report a unique case of successful replantation of scapulothoracic avulsion amputation in a child. In this manuscript, we discuss the various challenges faced during the procedure and chances of neural recovery.
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Affiliation(s)
- Sanjay Mahendru
- Department of Plastic, Reconstructive and Aesthetic Surgery, Medanta - The Medicity, Gurgaon, Haryana, India
| | - Rakesh Kumar Khazanchi
- Department of Plastic, Reconstructive and Aesthetic Surgery, Medanta - The Medicity, Gurgaon, Haryana, India
| | - Vimalendu Brajesh
- Department of Plastic, Reconstructive and Aesthetic Surgery, Medanta - The Medicity, Gurgaon, Haryana, India
| | - Akram Jawed
- Medanta Bone and Joint Institute, Medanta - The Medicity, Gurgaon, Haryana, India
| | - Aditya Aggarwal
- Department of Plastic, Reconstructive and Aesthetic Surgery, Medanta - The Medicity, Gurgaon, Haryana, India
| | - Hardeep Singh
- Department of Plastic, Reconstructive and Aesthetic Surgery, Medanta - The Medicity, Gurgaon, Haryana, India
| | - Sukhdeep Singh
- Department of Plastic, Reconstructive and Aesthetic Surgery, Medanta - The Medicity, Gurgaon, Haryana, India
| | - S Krishnan
- Department of Plastic, Reconstructive and Aesthetic Surgery, Medanta - The Medicity, Gurgaon, Haryana, India
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24
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Aman M, Festin C, Sporer ME, Gstoettner C, Prahm C, Bergmeister KD, Aszmann OC. Bionic reconstruction : Restoration of extremity function with osseointegrated and mind-controlled prostheses. Wien Klin Wochenschr 2019; 131:599-607. [PMID: 31201567 PMCID: PMC6908564 DOI: 10.1007/s00508-019-1518-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2018] [Revised: 05/22/2019] [Accepted: 05/25/2019] [Indexed: 12/17/2022]
Abstract
Background Loss of an extremity at any level has a major impact on a patient’s life. Using bionic reconstruction, extremity function can be restored and the patient reintegrated into daily life. Surgical procedures including selective nerve transfer and anchoring of prostheses into bone are combined with structured rehabilitation and modern prosthetic fitting. The patient is thereby able to use the prostheses intuitively and with multiple degrees of freedom. Methods This article presents the concept and approach for modern bionic reconstruction in detail and the relevant literature. The nerve transfer matrices for targeted muscle reinnervation (TMR) and the concept of osseointegration to optimally fit a patient with a modern prosthesis are described in detail. As a clinical example, the case of a patient who suffered from traumatic amputation and subsequently received TMR in combination with an osseointegrated implant and structured rehabilitation is presented. Results Using bionic reconstruction, basic hand functions can be restored and bimanual dexterity can expand the range of daily activities. Besides this approach to bionic reconstruction, its advantages and disadvantages are compared to hand transplantation. The limitations and perspectives of modern bionic reconstruction are also discussed. Conclusions Bionic reconstruction is a sophisticated method for restoring extremity function and nowadays can be considered a standard of care for all levels of upper extremity amputations. An interdisciplinary approach and structured rehabilitation are necessary to master prosthetic function to ultimately reintegrate patients into daily life.
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Affiliation(s)
- Martin Aman
- CD Laboratory for the Restoration of Extremity Function, Department of Surgery, Medical University of Vienna, Vienna, Austria.,Division of Biomedical Research, Medical University of Vienna, Vienna, Austria
| | - Christopher Festin
- CD Laboratory for the Restoration of Extremity Function, Department of Surgery, Medical University of Vienna, Vienna, Austria
| | - Matthias E Sporer
- CD Laboratory for the Restoration of Extremity Function, Department of Surgery, Medical University of Vienna, Vienna, Austria.,Division of Biomedical Research, Medical University of Vienna, Vienna, Austria
| | - Clemens Gstoettner
- CD Laboratory for the Restoration of Extremity Function, Department of Surgery, Medical University of Vienna, Vienna, Austria
| | - Cosima Prahm
- CD Laboratory for the Restoration of Extremity Function, Department of Surgery, Medical University of Vienna, Vienna, Austria
| | - Konstantin D Bergmeister
- Division of Biomedical Research, Medical University of Vienna, Vienna, Austria.,Division of Plastic and Reconstructive Surgery, Medical University of Vienna, Vienna, Austria
| | - Oskar C Aszmann
- CD Laboratory for the Restoration of Extremity Function, Department of Surgery, Medical University of Vienna, Vienna, Austria. .,Division of Plastic and Reconstructive Surgery, Medical University of Vienna, Vienna, Austria. .,Christian Doppler Laboratory for Restoration of Extremity Function, Division of Plastic and Reconstructive Surgery, Department of Surgery, Medical University of Vienna, Spitalgasse 23, 1090, Vienna, Austria.
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25
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Abstract
The indications for upper extremity replantation are fluid, and it has long been appreciated that they change with time. Traditional strong indications for replantation include hand, thumb, or multiple digit amputation in adults, and almost any amputation in a child. Patients often desire replantation of single nonthumb digits based on aesthetic preference and personal/cultural values. Replantation in these situations is acceptable and rewarding, but individual consideration of patient, injury, and circumstantial factors is critical to avoid patient morbidity and unsatisfactory outcomes.
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Affiliation(s)
- Mitchell A Pet
- Washington University School of Medicine, 660 South Euclid Avenue, St Louis, MO 63110, USA.
| | - Jason H Ko
- Northwestern University School of Medicine, NMH/Galter Room 19-250, 675 North Saint Clair, Chicago, IL 60611, USA
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26
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Yoshida N, Tsuchida Y. Forearm replantation after traumatic complete amputation. BMJ Case Rep 2018; 11:11/1/e227955. [PMID: 30567210 DOI: 10.1136/bcr-2018-227955] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Affiliation(s)
- Naoki Yoshida
- Department of Orthopedic Trauma Surgery, Shonan Kamakura General Hospital, Kanagawa, Japan
| | - Yoshihiko Tsuchida
- Department of Orthopedic Trauma Surgery, Shonan Kamakura General Hospital, Kanagawa, Japan
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27
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Spiers E. Managing vascular compromise of hand and digit replantation following traumatic amputation. ACTA ACUST UNITED AC 2018; 27:S50-S56. [PMID: 30418845 DOI: 10.12968/bjon.2018.27.sup20.s50] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Hands are anatomically complex and have great social, physical and emotional importance. Hand or digit replantation following traumatic partial or complete amputation is a complex injury for nursing staff to understand and manage. The absence of clear guidance, combined with a lack of consensus in the literature gives rise to ambiguity and insufficient understanding of appropriate and effective management. This article aims to outline nursing care of the patient in the first few days following hand or digit reattachment, particularly focusing on the recognition and management of arterial and venous compromise. Complications must be recognised and acted on quickly to give the best chance of survival so it is essential for nurses to have an accurate understanding of the signs, symptoms and management options of vascular compromise. Leech therapy, also discussed, has long been used as a nonsurgical option in the management of venous congestion and is a simple and minimally invasive method of managing congestion.
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Affiliation(s)
- Emma Spiers
- Military Burns and Plastics Nurse, The Queen Elizabeth Hospital, Birmingham
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28
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Abstract
OBJECTIVE To study the quality of life of Chinese pediatric patients with retinoblastoma (RB) after enucleation and the influencing factors. METHODS A questionnaire survey was performed on 71 cases of pediatric patients with RB after enucleation and 80 cases of healthy children, using the Pediatric Quality of Life Inventory 4.0 Generic Core Scales (PedsQL™ 4.0). RESULTS The social dimension scores, school dimension scores, and total scores for the PedsQL™ 4.0 among the pediatric patients with RB were statistically significantly lower than those of healthy children. The influencing factors were unilateral/bilateral affected eyes, diagnosis age, and ocular prosthesis satisfaction. CONCLUSION Early discovery, timely treatment, increased eye salvage rate, and cosmetic effects of ocular prosthesis were key factors for increasing the quality of life of pediatric patients with RB. Attention should be paid to the health, social, and school development of pediatric patients with RB.
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Affiliation(s)
- Lili Zhang
- Eye Center, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Tao Gao
- Eye Center, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Yi Shen
- Eye Center, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
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29
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Fletcher C. Case report and literature review of the outcome following reimplantation of the arm. Trauma Surg Acute Care Open 2017; 2:e000124. [PMID: 29766115 PMCID: PMC5887785 DOI: 10.1136/tsaco-2017-000124] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2017] [Revised: 08/19/2017] [Accepted: 08/22/2017] [Indexed: 11/04/2022] Open
Abstract
The following case report and literature review will detail the management of a traumatic amputation of the arm in a 12-year-old boy. Compared with lower limbs, upper limb prosthesis usually results in significant suboptimal function by any measure. While the literature lacks high-quality evidence with regard to functional outcomes following proximal amputations of the upper limb, especially in children, it is known that children generally have superior functional outcomes compared with their adult counterparts. The mechanism of injury, transportation of the amputated part, type of ischemia, timing of surgery, surgical techniques/factors and postoperative rehabilitation will be discussed as factors affecting outcome of reimplantation. LEVEL OF EVIDENCE V.
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Affiliation(s)
- Cary Fletcher
- Department of Ortthopeadics, St Ann's Bay Regional Hospital, St Ann's Bay, St Ann, Jamaica
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30
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Functional assessment and quality of life in patients following replantation of the distal half of the forearm (except fingers): A review of 11 cases. HAND SURGERY & REHABILITATION 2017; 36:261-267. [DOI: 10.1016/j.hansur.2017.05.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/04/2016] [Revised: 02/19/2017] [Accepted: 05/31/2017] [Indexed: 11/22/2022]
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31
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Pet MA, Morrison SD, Mack JS, Sears ED, Wright T, Lussiez AD, Means KR, Higgins JP, Ko JH, Cederna PS, Kung TA. Comparison of patient-reported outcomes after traumatic upper extremity amputation: Replantation versus prosthetic rehabilitation. Injury 2016; 47:2783-2788. [PMID: 28029356 DOI: 10.1016/j.injury.2016.10.004] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2016] [Revised: 10/03/2016] [Accepted: 10/08/2016] [Indexed: 02/02/2023]
Abstract
BACKGROUND After major upper extremity traumatic amputation, replantation is attempted based upon the assumption that outcomes for a replanted limb exceed those for revision amputation with prosthetic rehabilitation. While some reports have examined functional differences between these patients, it is increasingly apparent that patient perceptions are also critical determinants of success. Currently, little patient-reported outcomes data exists to support surgical decision-making in the setting of major upper extremity traumatic amputation. Therefore, the purpose of this study is to directly compare patient-reported outcomes after replantation versus prosthetic rehabilitation. METHODS At three tertiary care centers, patients with a history of traumatic unilateral upper extremity amputation at or between the radiocarpal and elbow joints were identified. Patients who underwent either successful replantation or revision amputation with prosthetic rehabilitation were contacted. Patient-reported health status was evaluated with both DASH and MHQ instruments. Intergroup comparisons were performed for aggregate DASH score, aggregate MHQ score on the injured side, and each MHQ domain. RESULTS Nine patients with successful replantation and 22 amputees who underwent prosthetic rehabilitation were enrolled. Aggregate MHQ score for the affected extremity was significantly higher for the Replantation group compared to the Prosthetic Rehabilitation group (47.2 vs. 35.1, p<0.05). Among the MHQ domains, significant advantages to replantation were demonstrated with respect to overall function (41.1 vs. 19.7, p=0.03), ADLs (28.3 vs. 6.0, p=0.03), and patient satisfaction (46.0 vs. 24.4, p=0.03). Additionally, Replantation patients had a lower mean DASH score (24.6 vs. 39.8, p=0.08). CONCLUSIONS Patients in this study who experienced major upper extremity traumatic amputation reported more favorable patient-reported outcomes after successful replantation compared to revision amputation with prosthetic rehabilitation.
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Affiliation(s)
- Mitchell A Pet
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Washington Medical Center, Seattle, WA, United States
| | - Shane D Morrison
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Washington Medical Center, Seattle, WA, United States
| | - Jacob S Mack
- Section of Plastic and Reconstructive Surgery, Department of Surgery, University of Michigan Health System, Ann Arbor, MI, United States
| | - Erika D Sears
- Section of Plastic and Reconstructive Surgery, Department of Surgery, University of Michigan Health System, Ann Arbor, MI, United States
| | - Thomas Wright
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Washington Medical Center, Seattle, WA, United States
| | - Alisha D Lussiez
- Section of Plastic and Reconstructive Surgery, Department of Surgery, University of Michigan Health System, Ann Arbor, MI, United States
| | - Kenneth R Means
- Curtis National Hand Center, MedStar Union Memorial Hospital, Baltimore, MD, United States
| | - James P Higgins
- Curtis National Hand Center, MedStar Union Memorial Hospital, Baltimore, MD, United States
| | - Jason H Ko
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Washington Medical Center, Seattle, WA, United States
| | - Paul S Cederna
- Section of Plastic and Reconstructive Surgery, Department of Surgery, University of Michigan Health System, Ann Arbor, MI, United States
| | - Theodore A Kung
- Section of Plastic and Reconstructive Surgery, Department of Surgery, University of Michigan Health System, Ann Arbor, MI, United States.
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