A retrospective study of upper arm replantation

MI Jing-yi; RUI Yong-jun; ZHAO Gang; HUA Yong; QIU Yang; YAO Qun; YU Jun; WANG Jun

doi:10.3969/j.issn.2095-252X.2015.12.010

Abstract：Objective To discuss the indication, surgical technique and rehabilitation of upper arm replantation by a retrospective study. Methods Twenty-two cases ( 2004-2012 ) of upper arm replantation were studied. The average age was 33.3 years old. In all patients, 81.8% were of rotation-twist-avulsion injury, and others were of crush-cut, wheel rolling or heavy crush injuries. The average MESS score was 7.5 points: 13 cases were 7, 7 cases were 8, 1 case was 9 and 1 case was 10. Ischemia time was 5-10 hours ( average: 8.1 hours ). Warm ischemia time was 4-7 hours ( average: 6.2 hours ). Different rehabilitation was performed at early, middle and late stage. Results Two patients were amputated at 5th and 10th day postoperatively due to muscle necrosis, severe infection or vessel ruptures. Twenty upper limbs survived. Seventeen patients were followed up from 3-10 years ( average:4.2 years ). The average DASH scores was 58.35±19.42 in 17 patients. According to Chen Zhong-wei’s criteria for limb replantation: 70.6% good, 29.4% fair, neither excellent nor poor. 64.7% patients satisfied with results or accepted the appearance of limb and 47.1% satisfied or accepted the function recovery. Conclusions Except for general surgical indications, revascularized time should be limited within 9 hours. The median nerve and radial nerve should be functionally repaired. Soft tissue defect should be early covered with cutaneous flap or muscle flap to protect nerve and vessel bundles, providing a basis for further function recovery. Long-term encouragement and guidance guarantee functional, psychological and social recovery of patients.