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. 2020 Oct 27;8(10):e3071.
doi: 10.1097/GOX.0000000000003071. eCollection 2020 Oct.

Functional Outcomes of Major Upper Extremity Replantation: A Scoping Review

Maleka Ramji  1 , Anna K Steve  1 , Zahra Premji  2 , Justin Yeung  1
Affiliations

Functional Outcomes of Major Upper Extremity Replantation: A Scoping Review

Maleka Ramji et al. Plast Reconstr Surg Glob Open. .

Abstract

Background: Traumatic upper limb amputations proximal to the carpus are devastating injuries. Existing literature on outcomes following replantation is limited. Our objective was to perform a scoping review of (1) functional outcomes; (2) return to work data; and (3) secondary surgeries required following proximal to carpus replantation.

Methods: A literature search of MEDLINE, EMBASE, Cochrane, and CINAHL was performed according to PRISMA guidelines. All studies reporting on functional outcomes, return to work, or secondary surgeries following replant of traumatic proximal to carpus amputation were included.

Results: Of the 753 articles, 13 studies were included, accounting for 136 major upper extremity replants (0 shoulder, 36 arm, 14 elbow, 86 forearm). Average age was 35 (24 -47) years, with average follow-up of 8 years (2 -18). Chen's Functional Criteria was the most common tool for reporting outcomes (10/13). Level of injury was related to functional outcome, with excellent to good Chen scores for replants distal to elbow, and poor Chen scores for replants at or proximal to elbow. Return to work correlated with level of replantation, with successful return for 65% of forearm, 43% of elbow, and 32% of arm replants. A mean of 2.4 secondary procedures were required.

Conclusions: This study provides insight into major upper extremity replantation, to assist in patient counseling and surgical decision making. Good functional outcomes and successful return to work are directly related to level of injury following major upper extremity replant. Patients should be counseled that more than 1 secondary procedure may be required.

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Conflict of interest statement

Disclosure: The authors have no financial interest to declare in relation to the content of this article.

Figures

Fig. 1.
Fig. 1.
PRISMA flow diagram.
Fig. 2.
Fig. 2.
Return to work, based on replant level. Return to work date for major upper extremity replants, based on level of replant.
See this image and copyright information in PMC

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