Five-Year Outcomes Following Regionalization of Upper Extremity Devascularization/Amputation Injuries (original) (raw)
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Replantation and revascularization vs. amputation in injured digits
Hand (New York, N.Y.), 2013
The purpose of this study was to analyze factors associated with the decision to replant or revascularize rather than amputate an injured digit as well as factors associated with successful replantation or revascularization. We reviewed 315 complete and subtotal amputations at or proximal to the distal interphalangeal joint in 199 adult patients treated over 10 years. Ninety-three digits were replanted (30 %), 51 were revascularized (16 %), and 171 were amputated (54 %), including 5 attempted replantations. Bivariate and multivariable analyses sought factors associated with replantation vs. amputation, revascularization vs. amputation, and success of replantation or revascularization. Factors associated with replantation rather than amputation were injury to the left hand, thumb, middle digit, and ring digit, more than one digit affected, and surgeon. Factors associated with revascularization are surgeon and shorter ischemia time. Forty-five replantations (48 %) and 41 revasculariza...
Hand Trauma Surgery: Where are we and where do we go?
tmj.ro
Datorită frecvenței crescute și a impactului funcțional, traumatismele mâinii au o serie de consecințe sociale și economice importante, atât pentru pacienți, cât și pentru societate. În ciuda faptului că în multe țări europene (Franța, Belgia, Elveția, Luxemburg) există preocupări mai vechi, iar în altele (Turcia) mai noi privind dezvoltarea unui sistem organizatoric eficient de prevenție și asistență a traumatismelor mâinii, România se confruntă încă cu multe probleme din acest punct de vedere. Vom încerca să evaluăm locul actual al traumatologiei mânii în țara noastră, sugerând principalele direcții pe care trebuie acționat în viitor. Cuvinte cheie: traumatisme ale mâinii, prevenție, tratament, costuri Due to their great frequency and functional impact, the hand traumas have a lot of important social and economical consequences for both the patients and society. Despite the fact that in many European countries (France, Belgium, Switzerland, Luxemburg) there is an older preoccupation or a new one (Turkey) regarding the development of a high standard organizational system for the prevention and assistance in hand traumatology, Romania is still confronting with many problems from this point of view. We will try to establish the actual place of hand traumas in our country and to suggest its main directions in the future.
Selected Outcomes of Thumb Replantation After Isolated Thumb Amputation Injury
The Journal of Hand Surgery, 2010
The aim of this study was to assess thumb survival, pinch strength, grip strength, and need for secondary surgery in patients undergoing thumb replantation after isolated thumb amputation injury. Methods We conducted a retrospective review of 52 consecutive isolated thumb replantations performed over a 4.5-year period. Charts were reviewed for mechanism of injury, level of amputation, and surgical technique. Primary outcomes of interest included survival and secondary surgery (eg, tenolysis, neurolysis) rates. Functional outcome was assessed by pinch and grip strengths after a mean follow-up period of 10 months from the initial injury. Results The overall thumb survival rate was 92% (48 of 52). One hundred percent of Zone I injuries (13 of 13), 94% of zone II injuries (29 of 31), and 75% of zone III injuries (6 of 8) survived; overall survival was 94% in sharp injuries (32 of 34), 89% in avulsion injuries (8 of 9), and 89% in crush injuries (8 of 9). Secondary surgery was performed in 18 patients with increasing need across the 3 zones (0%, 42%, and 63%, respectively; p for trend ϭ .002). Pinch and grip strengths of 17 patients after an average follow-up period of 10 months were significantly worse after crush/avulsion injuries (p ϭ .007 and .07, respectively) and injuries requiring joint intervention (p ϭ .004 and .02, respectively); grip strength was also found to be negatively associated with increasing zone of injury. Conclusions This retrospective study shows that a high rate of survival can be achieved after thumb replantation using current techniques. In addition, the need for secondary surgery is strongly related to zone of injury, with zone I injuries requiring the least amount of secondary surgery. Finally, pinch and grip strengths may be worse after crush or avulsion injuries and injuries requiring joint intervention.
Presentation and outcome of Hand trauma in a Plastic surgical unit. Ann Pak Inst Med Sci 2009; 5 (3) :131-5. , 2009
Objective: To determine the frequency of various causes of hand trauma and the pattern of outcome in terms of traumatic amputation of fingers / hand, duration of hospital stay, complications/ morbidity and mortality. Materials and Methods: All hand injured patients of either gender over 14 years of age, receiving treatment indoor or at outpatient department or managed in emergency department were included in the study by consecutive sampling technique. The sociodemographic profile of the patients, cause of injury, type of injury, type of surgical procedure undertaken, any complications and morbidity etc. were all recorded on a proforma. A follow-up of two months was done to document any late complications. The data were subjected to statistical analysis. Results: Out of a total of 138 patients, 84.78 % (n=117) were males while 15.21 % (n=21) were females. The mean age was 28 ± ± ± ± 11.35 years. Majority of the patients (69.56 %) were in their 2nd and 3rd decades of life. Two patients had left hand dominance while the remainder had right hand dominance. Occupation-wise 38.40% (n=53) patients were machine operators, 12.31%(n=17) were labourers / manual workers, while the remainder belonged to various other professions. Majority of the patients 63.04% (n=87) were socioeconomically poor. Machines constituted the commonest cause of hand trauma (38.40%), followed by road traffic accidents (15.94 %). Bone fracture was the most common injury (45.65 %), followed by cuts / lacerations (18.11 %) and fingertip losses (17.39 %). The rate of traumatic amputation of hand was 5.07 %. The rate of hospitalization was 11.59 %(n=16). The average hospital stay was 10.7 ± ± ± ± 5.40 days. There was no in-hospital mortality. Conclusion: Hand trauma predominantly affects young males who have occupational exposure to different machines. It is associated with a high rate of traumatic amputation of hand and digits. Most of the cases result from avoidable occupational hazards.
Severe complex injuries to the upper extremity: Revascularization and replantation
The Journal of Hand Surgery, 1991
Twenty-nine patients with an incomplete (26) or a complete (3) amputation of the upper extremity proximal to the wrist with revascularization or replantation were reviewed. Limb survival rates were very high (93%) despite the severity of the injuries. All patients regained some useful hand function, with 76% attaining a group I or group II (Chen criteria) functional result. Bone shortening osteotomies are a helpful way to reduce the soft tissue defect size. In contrast to earlier studies, clear correlations between the level of injury, degree of nerve lesion, bone pathology, and the number of major nerves involved, and the functional outcome achieved were not found. There was a weak correlation between the type of wound and the functional recovery ultimately obtained. (J HAND SURC 1991;16A:574-84.)
Hand injury without any deficit: Is systematic surgical exploration justified?
Hand Surgery and Rehabilitation, 2019
Out of 100,000 inhabitants, 700 to 4000 suffer a hand wound each year. Numerous hand wounds that may not have a clinically evaluated deficit, actually have damage to a major structure after surgical exploration in the operating room (OR). The aim of our study was to evaluate the incidence of major structure damage within a population of patients presenting a hand wound with no deficit on the clinical examination.
European Journal of Trauma and Emergency Surgery, 2020
Background Trauma to the hand is common and potentially serious, impairing daily living and general quality of life. Patients are often unable to work for several months, with hand function improving only gradually. Here, we review the epidemiology of hand injuries treated at a tertiary referral hospital in Warsaw, Poland. Material and methods In this single-centre, retrospective study, we reviewed medical records of patients presenting to the A&E Unit of the Plastic Surgery Department, Centre of Postgraduate Medical Education in Warsaw, Poland, between January 2001 and December 2005. We assessed a number of patient and injury characteristics, including severity, scored with the Hand Injury Severity Scoring System (HISS), and time off work. Results Of 1091 patients with a hand injury, 84% were male and over half were under the age of 40 years. Hand injury commonly resulted in tendon damage (56.1%), especially to finger flexors (79%), and in skin loss (37.8%). Amputations occurred in 24.1% of cases, while fractures (9.6%) and nerve (6.1%) or joint (5.5%) damage were less common. HISS-graded injury severity was moderate in 28.6% of cases, over half of the patients suffered severe (25.5%) or major (26.5%) injuries, and minor injuries were relatively uncommon (19.4%). Conclusions Amongst patients admitted to our Department, the most common injuries were tendon damage, skin loss, and amputations. Over half of the patients presented with severe or major injuries and took six months or longer to return to work, suggesting they were likely to face substantial social and economic consequences of their injury. Level of evidence IV: retrospective series.
Analysis of functional outcome of complex forearm injuries
International Journal of Research in Orthopaedics, 2017
Background: Complex forearm injuries are often associated with contamination, crushing, loss of tissues and patient arrives at odd hours when specialists are not available. These injuries can lead to complications like infective nonunion, stiffness, disabilities and secondary amputations. Methods: 23 patients having complex forearm injuries treated primarily at tertiary care center by single surgeon were included in the study. Pinch strength, grip strength, residual deformity and DASH score was assessed at final followup. In 23 patients treated, 16 patients underwent primary internal fixation of both bone, primary external fixator was done in 4 patient, delayed fixations in 6patients, primary bone grafting in 3 patients and in 1 patient delayed bone grafting was done Skin grafting was performed in 6 cases, and flaps in 13 patients. Vascular repair was done in four patients. Results: All 23 patients came for follow-up. An average number of surgery performed per patient was 3.81 and mean hospital stay of 28.2 days. The mean duration of follow up was 47.2 months. The average DASH score was 10.24 with average key and tip pinch and grip strength of 62.24%, 58.48% and 54.75% respectively. 3 patients had superficial infection and two patient deep infections. Superficial infections were managed with IV antibiotics. The patients with nerve and vascular injuries had higher DASH score. Conclusions: Early wound coverage can improve functional outcomes. Training in plastic coverage of wounds using pedicle flaps and skin grafting, microsurgical nerve and vessel repairs for orthopedic surgeon can be of great help for the patients.
HAND, 2019
Background: Indications for replantation following traumatic digit amputations are more liberal in the pediatric population than in adults, but delineation of patient selection within pediatrics and their outcomes have yet to be elucidated. This study uses a national pediatric database to evaluate patient characteristics and injury patterns involved in replantation and their outcomes. Methods: The Healthcare Cost and Utilization Project Kid’s Inpatient Database was queried for traumatic amputations of the thumb and finger from 2000 to 2012. Participants were separated into those who underwent replantation and those who underwent amputation. Patients undergoing replantation were further divided into those requiring revision amputation and/or microvascular revision. Patient age, sex, insurance, digit(s) affected, charges, length of stay, and complications were extracted for each patient. Results: Traumatic digit amputations occurred in 3090 patients, with 1950 (63.1%) undergoing revis...
Annals of plastic surgery, 2016
Hand trauma call duties at university medical centers are traditionally split among plastic surgeons and orthopedic surgeons, frequently without additional fellowship training in hand and upper-extremity surgery. Differences in operative approach between these groups have never been specifically described. The University Health Consortium-Association of American Medical Colleges Faculty Practice Solutions Center database contains comprehensive, factual, billing and coding data from 90 academic medical centers in the United States and can be used to characterize the practice patterns of various academic surgical specialties. To characterize and compare the clinical experience of academic plastic, orthopedic, and hand surgeons in addressing traumatic distal upper extremity injuries (using the Faculty Practice Solutions Center data set). Annual data for CPT defined procedures related to traumatic injuries of the nail bed, finger, hand, wrist, and forearm performed by plastic, orthopedi...