Original Article
상지절단 환자에서 시행된 재접합술의 추적관찰 결과
Upper Extremity Replantation for Patients with Major Amputation Injury: Follow-up Results of 11 Patients
Korean J Vasc Endovasc Surg 2013; 29(1): 10-16
Published February 28, 2013 https://doi.org/10.5758/kjves.2013.29.1.10
Copyright © The Korean Society for Vascular Surgery.
Abstract
Purpose: To report follow-up data on upper extremity (UE) macroreplantation in patients with traumatic amputation injuries.
Methods: Between 1996 and 2003, 11 patients underwent UE macroreplantation at a single institution. All patients had an open fracture (n=9; upper arm, 5; forearm, 4) or an open dislocation of the elbow (n=2), combined with neurovascular and soft tissue transection injuries. The replantation procedures were performed on an emergency basis by a multi-departmental team. The mean warm ischemic time was 328 minutes (range, 165 to 480 minutes). Functional recovery of the replanted UE was evaluated with Chen's classification system, and patient satisfaction was determined using Russell's questionnaire; periodic examinations were conducted over a minimum follow-up period of 2 years.
Results: Early complications consisted of 2 arterial thromboses, 1 soft tissue infection resulting in sepsis, and 1 episode of acute renal failure; UE reamputation was required in 2 patients. As a result, limb salvage was achieved in 82% of patients (9/11). A functional extremity, defined as grades I and II using Chen's criteria, was preserved in 33.3% of patients with successfully replanted limbs. Despite the objectively poor rate of function preservation, 89% of patients who had successful replantation procedures were satisfied with the results.
Conclusion: Even though the functional recovery rate was low, UE macroreplantation resulted in acceptable limb salvage rates and good patient satisfaction.
Keywords
Amputation, Upper extremity, Replantation
References
- Malt RA, McKhann C. Replantation of Several Arms. JAMA 1964;189:716-722.
- Leclere FM, Mathys L, Juon B, Franz T, Unglaub F, Vogelin E. Macroreplantations of the upper extremity: a series of 11 patients. Arch Orthop Trauma Surg 2012;132:1797-1805.
- Chung-Wei C, Yun-Qing Q, Zhong-Jia Y. Extremity replantation. World J Surg 1978;2:513-524.
- Russell RC, O’Brien BM, Morrison WA, Pamamull G, MacLeod A. The late functional results of upper limb revascularization and replantation. J Hand Surg Am 1984;9:623-633.
- Medical Research Council. Aids to the examination of the peripheral nervous system: memorandum no. 45. London: Her Majesty’s Stationery Office; 1981.
- Meyer VE. Upper extremity replantation: a review. Eur Surg 2003;35:167-173.
- Graham B, Adkins P, Tsai TM, Firrell J, Breidenbach WC. Major replantation versus revision amputation and prosthetic fitting in the upper extremity: a late functional outcomes study. J Hand Surg Am 1998;23:783-791.
- Neumeister MW, Brown RE. Mutilating hand injuries:principles and management. Hand Clin 2003;19:1-15, v.
- Tintle SM, Baechler MF, Nanos GP 3rd, Forsberg JA, Potter BK. Traumatic and trauma-related amputations: part II: upper extremity and future directions. J Bone Joint Surg Am 2010;92:2934-2945.
- Chew WY, Tsai TM. Major upper limb replantation. Hand Clin 2001;17:395-410, viii.
- Raja Sabapathy S. Management of complex tissue injuries and replantation across the world. Injury 2006;37:1057-1060.
- The Hoang N, Hai LH, Staudenmaier R, Hoehnke C. Complete middle forearm amputations after avulsion injuries:microsurgical replantation results in Vietnamese patients. J Trauma 2009;66:1167-1172.
- O’Brien BM, Macleod AM, Hayhurst JW, Morrison WA, Ishida H. Major replantation surgery in the upper limb. Hand 1974;6:217-228.
- Malt RA, Remensnyder JP, Harris WH. Long-term utility of replanted arms. Ann Surg 1972;176:334-342.
- Waikakul S, Vanadurongwan V, Unnanuntana A. Prognostic factors for major limb re-implantation at both immediate and long-term follow-up. J Bone Joint Surg Br 1998;80:1024-1030.
- Ipsen T, Lundkvist L, Barfred T, Pless J. Principles of evaluation and results in microsurgical treatment of major limb amputations: a follow-up study of 26 consecutive cases 19781987. Scand J Plast Reconstr Surg Hand Surg 1990;24:75-80.
- Goldner RD, Nunley JA. Replantation proximal to the wrist. Hand Clin 1992;8:413-425.
- Eisenhardt HJ, Isselhard W, Prangenberg G, Pichlmaier H, Klein PJ. Energy metabolism and histomorphological findings in replanted rat hind limbs using various conservation methods. Microsurgery 1984;5:61-69.
- Skjeldal S, Grogaard B, Nordsletten L, Reikeras O, Svindland A, Torvik A. Protective effect of low-grade hypothermia in experimental skeletal muscle ischemia. Eur Surg Res 1992;24:197-203.
- Daigle JP, Kleinert JM. Major limb replantation in children. Microsurgery 1991;12:221-231.
- Sugun TS, Ozaksar K, Ada S, Kul F, Ozerkan F, Kaplan I, et al. Long-term results of major upper extremity replantations. Acta Orthop Traumatol Turc 2009;43:206-213.
- Patradul A, Ngarmukos C, Parkpian V. Major limb replantation:a Thai experience. Ann Acad Med Singapore 1995;24(4 Suppl):82-88.
- Kleinert HE, Jablon M, Tsai TM. An overview of replantation and results of 347 replants in 245 patients. J Trauma 1980;20:390-398.
- Lindfors N, Marttila I. Replantation or revascularisation injuries in children: incidence, epidemiology, and outcome. J Plast Surg Hand Surg 2012;46:359-363.
- Saies AD, Urbaniak JR, Nunley JA, Taras JS, Goldner RD, Fitch RD. Results after replantation and revascularization in the upper extremity in children. J Bone Joint Surg Am 1994;76:1766-1776.