4.1 LONG-TERM RESULTS AFTER MACROREPLAN-TATION OF THE UPPER LIMBR. Hierner 1 and A. Berger 21 University Hospital Gasthuisberg, Belgium;2 Medical University Hannover, Hannover, GermanyBackground: With current therapeutic and technologicaladvances, surgeons have the ability to salvage viabilityin most severe upper limb injuries. Nowadays restora-tion of limb viability alone is not suff i cient to fulf i ll thecriteria of a successful replantation.Patients and methods: Using our personal series of 65patients operated between 1981 and 1993 (upper arm:n ¼ 18, proximal and middle forearm: n ¼ 32, distalforearm and wrist level: n ¼ 15) and the results of anextensive literature review the following criteria wereevaluated: (1) survival rate, (2) possible individual motorand sensory functions of the extremity, (3) global upperextremity function assessed according to the CHENclassif i cation, (4) socioeconomic aspects, (5) number andnature of local and/or systemic complications, and (6)subjective patient judgment.Results: Survival rate of upper limb replantation, whichonly means perfect restoration of viability, was about76% to 92%. The more distal the amputation level was,the better individual motor and sensory function was ofthe ‘‘functional chain upper extremity’’. Taking grade Iand II results together a ‘‘functional extremity’’ can bereconstructed at the upper arm level in 22% to 34%, atthe proximal forearm level in 30% to 41% and at thedistal forearm level in 56% to 80%. All patients neededat least 2 secondary operative procedures. Five of 65patients were re-amputated because of postoperativecomplications.Conclusion: Since the functional results after replanta-tion are at least equal (proximal level) or even farsuperior (distal level), compared to amputation andprosthesis f i tting, and since some protective sensitivity atthe hand can be expected even at the most proximallevels, replantation should be carried out if possible. Inaddition, upper limb replantation may prevent psycho-logical impairment caused by incomplete body integrity.10.1016/j.jhsb.2006.03.1094.2 REPLANTATION FOLLOWING SEVERE UPPERLIMB INJURYR. Friedel, R. Schmidt, T. Donicke and G. HofmannFriedrich-Schiller-University Jena, GermanyBackground: Upper extremity trauma can be a cause ofsignif i cant morbidity and disability to otherwise pro-ductive people. Upper limb replantation after traumaticamputation can be performed with reasonable success ata regional medical centre if experienced surgeons,appropriate equipment, and skilled ancillary care areavailable.Patients and methods: Of 36 patients between 14 and 70years (median, 38 years) at the time of injury, 20 hadsuffered a total upper limb amputation and 16 a subtotalone. Three patients had multiple concomitant injuries.Only 10 per cent of all amputations were clean cutinjuries. The average ischaemia time was 5.9h (range,3.5–5.8h) in subtotal amputations and 5h (range,3.5–7.0h) in total amputations. Replantation failed inthree patients following complete amputation. In threepatients replantation was not indicated because of severesoft-tissue loss. All 16 patients with a subtotal amputa-tion showed long-term survival of the replantated upperlimb. The Mangled Extremity Severity Score (MESS) ofsecondarily amputated patients averaged 8.25, while itwas 6.73 for successfully replantated patients. The latterunderwent on average 4.4 surgical interventions follow-ing the initial replantation. Median follow-up was 3years in 14 of all 36 patients. Their functional outcomeaccording to the CHEN Score was 3.2 (n ¼ 8) for totaland 2.6 (n ¼ 6) for subtotal amputations. The meanDASH-score was 53.0 for patients with total amputa-tions and 33.3 for those with subtotal amputations.Conclusion: The advantage of upper extremity replanta-tion over amputation and replacement with a contem-porary prosthesis, is the possibility for the patient torecover a limb with protective sensitivity and at leastpartial active motion. The MESS-score provides a goodpredictor value for indication of replantation. Patientswith multiple injuries are not an absolute contraindica-tion for replantation.10.1016/j.jhsb.2006.03.1104.3 OUR STRATEGY IN CRUSH TRAUMA OF THEUPPER LIMBA. Georgescu, B. Baldea, S. Barsan, I. Matei andI. CapotaUniversity of Medicine, Cluj-Napoca, RomaniaBackground: The high incidence of upper limb crushtrauma stimulated imagination of surgeons to f i ndsuitable surgical salvage techniques and strategies.Microsurgical techniques allowed free f l aps to solvethe problem, if l ocal and/or regional f l aps were notfeasible.. The importance of the so-called ‘‘per primamintentionem’’ repair is outlined for all anatomicallesions.Material and methods: Between 1991 and 2005, 691patients with destructive injuries of the upper limb weretreated in our service. A total of 259 were crush injuries,of which 48 were complete or partial amputations. Ourstrategy involved emergency upper limb reconstruction,ARTICLE IN PRESSMICRO 17
