East Lansing and Ann Arbor, Mich. From the College of Human Medicine, Michigan State University; and the Section of Plastic Surgery, Department of Surgery, University of Michigan.
Plast Reconstr Surg. 2013 Oct;132(4):911-919. doi: 10.1097/PRS.0b013e31829f4a49.
Little knowledge exists concerning replantation following traumatic major upper extremity amputation. This study characterizes the injury patterns and outcomes of patients suffering major upper extremity amputation and ascertains clinical factors associated with the decision to attempt replantation.
A retrospective cohort study was conducted on patients treated at a Level I trauma center between June of 2000 and August of 2011. Patients who experienced traumatic upper extremity amputation at or proximal to the radiocarpal joint were included in the study. The subset of patients subsequently undergoing replantation was identified. Medical records were reviewed and bivariate analysis was performed to identify factors associated with attempted replantation and replant survival.
Sixty-two patients were treated for traumatic upper extremity amputation and 20 patients underwent replantation. Injury factors associated with attempted replantation included a sharp/penetrating injury (p = 0.004), distal level of amputation (p = 0.017), Injury Severity Score less than 16 (p = 0.020), absence of avulsion (p = 0.002), absence of significant contamination (p ≤ 0.001), and lack of multilevel involvement (p = 0.007). Replantation exhibited a complete replant survival rate of 70 percent. An Injury Severity Score of 16 or more was associated with replant failure (p = 0.004). Patients who underwent replantation demonstrated increased rates of secondary surgical revisions (p ≤ 0.001) and complications (p = 0.023) and had a greater length of hospital stay (p = 0.024).
Several injury characteristics are associated with the decision to attempt replantation of the major upper extremity. A high global injury severity (Injury Severity Score ≥ 16) is associated with replantation failure when attempted. Patients who undergo replantation demonstrate higher resource use, warranting further cost-analysis and outcomes investigation.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, III.
关于创伤性上肢大截肢后的再植术，人们知之甚少。本研究描述了上肢大截肢患者的损伤模式和结局，并确定了与尝试再植术相关的临床因素。
对 2000 年 6 月至 2011 年 8 月期间在一级创伤中心治疗的患者进行回顾性队列研究。纳入研究的患者为桡腕关节或其近端发生创伤性上肢截肢的患者。确定随后进行再植术的患者亚组。查阅病历并进行双变量分析，以确定与尝试再植术和再植存活相关的因素。
62 例患者因创伤性上肢截肢接受治疗，20 例患者接受再植术。与尝试再植术相关的损伤因素包括锐器/穿透伤（p = 0.004）、截肢部位远侧（p = 0.017）、损伤严重程度评分<16（p = 0.020）、无撕脱伤（p = 0.002）、无明显污染（p ≤ 0.001）、无多节段受累（p = 0.007）。再植术的完全再植存活率为 70%。损伤严重程度评分≥16 与再植失败相关（p = 0.004）。接受再植术的患者表现出更高的二次手术修订率（p ≤ 0.001）和并发症发生率（p = 0.023），且住院时间更长（p = 0.024）。
一些损伤特征与决定尝试再植上肢大截肢有关。当尝试时，高的总体损伤严重程度（损伤严重程度评分≥16）与再植失败相关。接受再植术的患者需要更多的资源，这需要进一步的成本分析和结果调查。
临床问题/证据水平：风险，III 级。
