Quality of life-oriented evaluation of late functional results of hand replantation

Abstract

Background: Forearm amputation in different zones via a similar mechanism in a group of patients of similar age is associated with different possibilities of functional recovery. The degree of postoperative recovery of function is invariably partial compared to pre-amputation function; this kind of trauma inevitably leads to disability. The patients adapt to their new circumstances to a different extent. That is why a quality of life evaluation should be included in the assessment of replantation outcomes. The aim of the study was to evaluate functional outcomes in patients after replantation at the metacarpal, wrist and mid-forearm level with regard to the quality of life of this patients.

Material and methods: Thirty patients (29 men, 1 woman) of an average age of 41 years who had had replantation or revascularization surgery of an upper limb at different levels took part in a randomized study. The patients were divided into 3 groups depending on the level of amputation: metacarpal, wrist, mid-forearm, with 10 patients in each group. Amputations had been done by a circular saw (21) or via a guillotine mechanism (9). The patients were evaluated on average 4.2 years postoperatively. The following parameters were assessed: total range of active motion (the long finger with the greatest range of motion was assessed) (TAM), grip strength, and sensation; patients performed the Nakamura-Tamai test (modified). Overall functional outcomes were assessed according to Chen's classification. The quality of life (QoL) was measured with the SF-36 questionnaire (0-136 points). The correlation of functional and QoL results was assessed by Spearman's non-parametric test.

Results: Average TAM was: 167 degrees in metacarpal, 174 degrees in wrist, 114 degrees in mid-forearm group; grip strength was 0.7 N, 0.9 N and 0.6 N respectively. All patients had at least protective sensation, whereas a 2PD of less then 10 mm was present in 4 patients in the metacarpal group, and 6 patients in the wrist group. In Chen's classification 5 patients in metacarpal group were rated as grade I and II, compared to 7 in the wrist group, and 2 in the forearm group. QoL scores were 98.9, 104 and 82 respectively. A strong QoL-function correlation was confirmed in the wrist and forearm groups (0.73 - 0.81 respectively), and in the metacarpal group it was weak (0.43).

Conclusion: The quality of life of patients of the designated groups was correlated with their functional results.