Journal Article

Disability and health after replantation or revascularisation in the upper extremity in a population in southern Sweden – a retrospective long time follow up

Rosberg, Hans-Eric

2014

Overview

Background Replantation in the upper extremity is a well-established microsurgical procedure. Many have reported patients’ satisfaction and functional measurements. The aim was to investigate the long time consequences as activity limitations in hand/arm, the general health and cold sensitivity after a replantation or revascularization in the upper extremity and to examine if sense of coherence (SOC) can be an indicator for rehabilitation focus. Methods Between 1994–2008, 326 patients needed replantation/revascularization in the upper extremity. 297 patients were followed up. Information was collected from the medical notes and by questionnaires [Quick-DASH (disability hand/arm), EuroQ-5D (general health), CISS (cold sensitivity) and SOC (sense of coherence)]. Severity of injury was classified with the modified Hand Injury Severity Score (MHISS). Results The patients [272 (84%) men and 54 (16%) women; median age 39 years (1–81 years)], where most injuries affected fingers (63%) and thumb (25%), commonly affecting the proximal phalanx (43%). The injuries were commonly related to saws (22%), machines (20%) and wood splints (20%). A direct anastomosis (30%) or vein grafts (70%) were used. The overall survival was 90%. 59% were classified as Major. Equal parts of the injuries took part during work and leisure, DASH scores at follow up were worse (p = 0.005) in the former. Twenty percent changed work and 10% retired early. Patients with early retirement were significantly older, had a more severe injury, worse disability, quality of life and functional outcome. Median DASH score was low [11.4 (0–88.6)] and correlated with severity of injury. Abnormal cold sensitivity (CISS > 50) was seen in 51/209 (24%) and they had a worse disability, quality of life, functional outcome and lower SOC. Patients with a low SOC had on the whole a worse outcome compared to patients with a high SOC and with significant differences in age, EQ-5D, Quick-DASH and CISS. Conclusions A high MHISS, abnormal cold intolerance and a low SOC seems to be factors influencing the patients’ outcome and might be relevant in the rehabilitation of the patients. Also, those who had to retire early had a worse disability, quality of life and functional outcome.

• Publisher: BioMed Central,BioMed Central Ltd,Springer Nature B.V
• Subject: Adolescent / Adult / Aged / Aged, 80 and over / Amputation, Traumatic - surgery / Analysis / Anastomosis, Surgical / Child / Child, Preschool / Clinical Medicine / Cold / Cold Temperature - adverse effects / Disability Evaluation / Early retirement / Epidemiology / Female / Follow-Up Studies / Hand - blood supply / Hand - surgery / Hand Injuries - rehabilitation / Hand Injuries - surgery / Hospitals / Humans / Hyperesthesia - etiology / Hyperesthesia - psychology / Infant / Injuries / Internal Medicine / Klinisk medicin / Male / Medical and Health Sciences / Medicin och hälsovetenskap / Medicine / Medicine & Public Health / Microsurgery / Middle Aged / Occupational Injuries - rehabilitation / Occupational Injuries - surgery / Orthopaedics / Orthopedics / Orthopedics and biomechanics / Ortopedi / Postoperative Complications - epidemiology / Postoperative Complications - psychology / Quality of Life / Questionnaires / Recovery of Function / Rehabilitation / Replantation / Research Article / Retrospective Studies / Rheumatology / Sports Medicine / Studies / Surgery / Surveys and Questionnaires / Sweden - epidemiology / Treatment Outcome / Vascular Surgical Procedures - rehabilitation / Veins - transplantation / Young Adult