gms | German Medical Science

Objectives/Interrogation: The long term results of major upper extremity replantations are evaluated with the functionality of the extremity and the occupational and biopsychosocial status of the patient. In this study, we aimed to compare the long term functionality of a case with replantation under direct vision with another case with replantation by microsurgery.

Methods: Two seventeen year old male patients were referred with above elbow, clean cut amputations at their non-dominant left hands. The pressman (#1) had a guillotine type accident whereas the carpenter (#2) had a saw trauma. The ischemia times were less than 5 hours for both patients. The radial and ulnar arteries of the #1 was operated under direct vision whereas standard microsurgical anastamoses were performed for the #2. The bones were stabilized with intramedullary nailing for both cases. The median and ulnar nerves were coapted in both cases. In the #1, the nerves were repaired with non-absorbable 6/0 sutures epineurally wheres they were repaired with non-absorbable 9/0 sutures epiperineurally in the #2. Both of the patients received standard hand physiotherapy.

The following tests and evaluations were done for 37 and 42 years: Semmes - Weinstein monofilament test, vibration test, 2 point discrimination test, localisation test, grip and pinch strength measurements, motor evaluation, Chen criteria, DASH and ADL.

Results and Conclusions: During the early postoperative period, distal necrosis was seen at the tip of the fourth finger of the #1, requiring a revision amputation. Early complications were not seen in the #2. Total osseous union was achieved in both patients. Both patients returned to their occupations two years after the surgery, and the #2 completed his military service four years after the surgery. The Semmes - Weinstein test was 2.83 for both of the patients and two point discrimination at all the fingers were 4 milimeters for the #1 and 3 milimeters for the #2. In both patients, the grip and pinch strengths were comparable with the unaffected dominant hand. The thenar and intrinsic muscle functions were satisfactory in both cases. The recovery of both patients were found to be Chen Class I. The cases have the longest followup period after major upper extremity replantations with satisfactory function in Turkey.