Functional Results of Upper Limb Replantation Surgery at the Wrist or Forearm Level: Twelve-Year Experience.

After the first successful replantation of an arm in 1962 (Malt, McKhann), microsurgical and reconstructive techniques have advanced considerably. The authors presented the functional results of major upper limb replantations performed at their institution.

Between 1992 and 2003, 13 patients had a replantation at wrist or forearm level. Six patients had a complete amputation and seven a subtotal amputation with peripheral ischemia. All were considered to be candidates for replantation. The mean age was 41 years. The mean follow-up time was 62 months. In two patients, there was a guillotine type of amputation, in six a crush amputation with local tissue damage, in four patients a crush amputation with extensive tissue damage, and in one case an avulsion amputation.

Patients underwent a functional evaluation using different scores (Tamai, Chen, Burton). To evaluate the subjective outcome the DASH score was used. Additionally, recovery of sensibility was tested with the Semmes-Weinstein-Test.

All but one replanted upper extremity survived. The patients with successful replantations were satisfied with the functional outcome. The mean DASH score was 40. According to the Tamai score, one patient was classified in group I, eight patients in group II, and three patients in group III. According to the Chen classification, one patient was in group I, five in group II, and six patients in group III. The mean score according to the Burton classification was 66. Sensory recovery was poor, with most patients having a moving 2pd up to 20 mm. All patients regained some kind of useful protective sensibility.

The functional results of the patients were comparable to those reported in the literature. Although the objective functional result was limited, all patients expressed great satisfaction after replantation. The main problem is still the often disappointing outcome of nerve repair.