Evaluation of upper extremity replantation and revascularization practices

Evaluation of upper extremity replantation and revascularization practicesIn finger and extremity replantation the goal is not only keeping alive the amputated part. The functions of the replantated part should be better than a prosthesis as well. We can talk about success if 60-80% range of motion of the joint is achieved together with motor and sensorial functions. The success depends on correct repairment of all parts, such as bone, tendon, muscle, vessel and nerve, of the amputated organ.Minor replantation and revascularization of the upper extremity in 30 patients were performed at Inonu University Turgut Ozal Medical Center between 2008 and 2011. Surgery was performed for 35 fingers in a total of 30 patients whose finger(s) were totally or subtotally amputated because of trauma.In the first group, 15 replantations were performed for finger amputation in 15 patients. In the second group 20 revascularization were performed for subtotal amputated fingers in 15 patients. Twenty-eight patients were evaluated after surgery and after an average 17 months (6 months-3.5 year) follow-up period. Results were compared with literature.British medical research council scoring system was used for motor strenght and sensorial functions and Chen criteria for late term functional results.When early term results were analyzed, living rate was 93.3% at replantated fingers, 80% at revascularizated fingers,66.6% at injuries zone 2 level, 92.3% at injuries zone 3 level, 100% at guillotine-type injuries and 68.8 at crush and avulsion type injuries. When functional results were analyzed according to patterns of injury,we found good - very good results at 89.9% of the patients injured guillotine type and 33.3% of the patients injured crush and avulsion type.As a result, with the statistical analyses made by using X2 test, we found that,living rates and functional results of the distal parts were significiantly better at patients with guillotine-type injuries than patients with crush and avulsion types.Key words:Replantation,revascularization, total amputation, subtotal amputation