Department of Plastic and Reconstructive Surgery, Erasmus MC Rotterdam, Rotterdam, The Netherlands.
J Reconstr Microsurg. 2020 Mar;36(3):213-222. doi: 10.1055/s-0039-3400515. Epub 2019 Nov 22.
Microsurgical reconstruction of upper extremity injuries is often challenging, and the resulting impact on the quality of life (QoL) may be significant. However, there is a lack of knowledge on long-term patient-reported QoL.
In a retrospective long-term follow-up study, all consecutive patients with an upper extremity injury who had undergone a free flap reconstruction were identified and categorized into three groups based on the type of injury. Patient-reported upper extremity function and QoL were assessed using three validated questionnaires: the 36-item Short Form Health Survey (SF-36), the Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire, and the Michigan Hand Outcomes Questionnaire (MHQ).
A total of 61 patients were identified, of whom 10% had undergone a free flap reconstruction for soft tissue loss only, 62% for an injury accompanied by a fracture, and 28% for a (sub) total amputation. Twenty-one (44%) patients responded to the questionnaires, with a mean follow-up time of 9.7 ± 6.2 years. Patients, on average, reported poorer SF-36 "physical component score" and "role limitations due to physical health" scores compared with Dutch norms. Also, they reported poorer mean DASH scores compared with the general population, indicating worse upper extremity function. Mean MQH scores were lower for the injured side compared with the noninjured side. Pain correlated negatively with the total scores of DASH, MHQ, and SF-36.
Free flap upper extremity reconstruction is challenging. At 10 years of follow-up, the injury and its treatment continued to have a significant impact on the upper extremity function and daily QoL, with chronic pain being an important factor negatively affecting these outcomes.
上肢损伤的显微重建常常具有挑战性，其对生活质量（QoL）的影响可能是显著的。然而，对于长期患者报告的 QoL，我们知之甚少。
在一项回顾性长期随访研究中，我们确定了所有接受游离皮瓣重建的上肢损伤连续患者，并根据损伤类型将其分为三组。使用三个经过验证的问卷评估患者报告的上肢功能和 QoL：36 项简短健康调查（SF-36）、上肢残疾问卷（DASH）和密歇根手功能问卷（MHQ）。
共确定了 61 例患者，其中 10%的患者因单纯软组织损失接受了游离皮瓣重建，62%的患者因伴有骨折的损伤接受了游离皮瓣重建，28%的患者因（部分）完全截肢接受了游离皮瓣重建。21 例（44%）患者对问卷做出了回应，平均随访时间为 9.7±6.2 年。与荷兰常模相比，患者平均报告 SF-36“生理成分评分”和“因生理健康导致的角色限制”评分较低。此外，与一般人群相比，他们报告的 DASH 平均评分较差，表明上肢功能更差。与非损伤侧相比，损伤侧的 MHQ 评分较低。疼痛与 DASH、MHQ 和 SF-36 的总分呈负相关。
游离皮瓣上肢重建具有挑战性。在 10 年的随访中，损伤及其治疗继续对上肢功能和日常生活质量产生重大影响，慢性疼痛是一个重要的负面因素，影响这些结果。
