Philippine Journal of Surgical Specialties Vol. 66, No. 2, April-June, 2011, pp 52-59

Results of Microsurgical Replantation and Revascularization Surgery of the Hand and Wrist

Author(s): Emmanuel P. Estrella, M.D. and Tammy L. Dela Rosa, M.D., M.Sc

The objective of this paper was to present the results of replantation and revascularization surgery of the hand or digit and to describe the factors associated with survival of the replanted and revascularized digit.

From January 1, 2005 to July 31, 2010, a retrospective review of the Microsurgery Unit Database was done to determine the number of patients referred to the Unit for amputations of the upper extremity. The injuries were classified by mechanism of injury (guillotine, crush, avulsion, and gunshot/blast), level of injury, and whether or not a vein graft was used. A total of 8 patients with 8 hand parts had replantation surgery and seven patients with 10 revascularized parts were reviewed.

Functional Outcome:
Functional outcome was measured using the range of motion of the involved digit or body part using a finger or standard goniometer. Sensory recovery of the replanted or revascularized part was measured using the static 2-point discrimination test.

A total of 86 patients from January 2005 to July 2010 suffered amputation or near amputation injuries that were referred to the Microsurgery Unit. Of these patients, 8 patients with 8 hand parts had replantation surgeries while 7 patients with 10 hand parts had revascularization surgeries. In total, there were 15 patients (14 males and 1 female) with an average age of 26.2 years old (range, 4-68 years old). The overall viability rate was 72.2% (62.5% for replantation surgery and 80% for revascularization surgery). The average follow-up of the patients who had a successful replantation procedure was 19 months (range, 3-48 months). Those who had successful revascularization procedures after partial or near amputation of the hand or fingers had an average of 7.3 months follow-up (range, 3-14 months).
Functional Outcome:
Four of the 12 patients had no functional results because of no recovery yet was expected on recent follow-up. In all digital replantations, stiffness was present even after 6 months post replantation. Of the 5 patients who had successful replantation surgery, only 4 had functional results. The best results were from the through-wrist and through-palm amputations. Protective sensation was achieved in all tested patients.
Successful replantation and revascularization surgery mainly depend on the mechanism of injury. Crush injuries tend to have poorer prognosis compared to guillotine type injuries. Replantation and revascularization surgeries require intensive post-operative rehabilitation to maximize the functional outcome.

Key words: replantation, revascularization