Hand function after replantation or revascularization of upper extremity injuries. A follow-up study of 21 cases operated on 1979-1985 in Göteborg.

Twenty-one patients with revascularized/replanted amputated parts of the upper limb were studied for an evaluation of hand function. Two patients had been injured at the lower arm to wrist level, four between the wrist and MCP joint, three distal to the MCP joints in thumbs and/or fingers, and twelve in the thumb only. Hand function was measured as grip and pinch strength, range of movement (ROM), sensibility (two point discrimination), and Sollerman test score. Cold sensitivity as related to circulatory changes in the replanted limb was evaluated in six patients using the critical opening test (COP). Twelve of 17 initiated replantations (71%), and 11 of 12 revascularizations (92%), were successful. Hand function was restricted in patients with amputations at the lower arm to wrist level, fair in replanted midhands, good, but with wide variations after replantations at the MCP or distal II-V fingers, and best of all in replanted thumbs. Sensibility was poor in a majority of the patients. Three out of six of the patients who were COP-tested had significantly reduced blood pressure in the replanted part. The test results (grip, ROM, Sollerman score) in three patients with amputated thumbs were not found to differ greatly from those with replanted thumbs. These results raise the question of whether the Sollerman test underestimates the importance of the thumb or whether the thumb is overestimated in hand function.