ArticleWorld journal of emergency surgery : WJES2015
Severe mutilating injuries with complex macroamputations of the upper extremity - is it worth the effort?
Article in World journal of emergency surgery : WJES, 2015. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 11 papers.
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Who cites it
11 citing papers in PubMed, 25 citations in OpenAlex.
- Microsurgical replantation of severely crushed and contaminated amputated limbs in children: Case reports and surgical insights.JPRAS open · 2026Article
- Piezo1 activation in endothelial cells aggravates microvascular ischemia-reperfusion injury in limbs by enhancing ferroptosis.Experimental & molecular medicine · 2026Article
- Risk factors and predictors of prolonged hospital stay in the clinical course of major amputations of the upper and lower extremity a retrospective analysis of a level 1-trauma center.European journal of trauma and emergency surgery : official publication of the European Trauma Society · 2024Article
- Patient-reported significant disability after major traumatic upper extremity amputation.The Journal of hand surgery, European volume · 2024Article
- CAN TEMPORARY ARTERY CATHETERIZATION EXTEND LIMITS OF ISCHEMIA TIME FOR MACROREPLANTATION?Acta ortopedica brasileira · 2023Article
- Nerve merging repair in the replantation of a severed limb with defects in multiple nerves: five cases and long-term follow-up.BMC surgery · 2022Article
- Functional Outcomes of Major Upper Extremity Replantation: A Scoping Review.Plastic and reconstructive surgery. Global open · 2020Article
- Quality of life and reconstructive surgery efforts in severe hand injuries.Innovative surgical sciences · 2018Article
- Successful Hand Replantation in a Case of Total Avulsion without Vein Graft.Plastic and reconstructive surgery. Global open · 2018Article
- Outcomes and Disability After Massive Proximal Upper Extremity Reconstruction in a Resource-Limited Setting.World journal of surgery · 2017Article
- Measuring Functional and Patient-Reported Outcomes After Treatment of Mutilating Hand Injuries: A Global Health Approach.Hand clinics · 2016Review
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Authors and funding
3 authors at 2 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
introductionAn amputation of the upper extremity and the following replantation is still one of the most challenging operations in the field of reconstructive surgery, especially in extremely severe cases of combined mutilating macroamputations including avulsion and multilevel injuries. Specialists agree that macroamputations with sharp wound edges are an absolute indication for replantation. However, there is no agreement in disastrous cases including avulsion and multilevel injuries. The outcome of the operation is depending on several factors, including the type of accident, age and pre-existing disease of the patient, as well as time of ischemia and appropriate physical therapy.
methodsBetween January 1(st) 2003 and December 31(st) 2011 six patients underwent a macroreplantation with disastrous combined and complex injuries of the upper extremity in our department. We performed a follow up and evaluated the functional outcome of the upper extremity function using the DASH questionnaire (average follow up of 3.1 years).
resultsThe mean time of ischemia was 04:50 h (02:46 h-06:17 h). The mean time for the operation was 05:30 h (01:55 h-08:20 h). The mean operations needed per patient were 7 (2-16). The average hospital stay was 29d (16-59d). According to the DASH-Score from five out of six patients the functional outcome of the replanted extremity has a mean score of 71 points. The versatility of the replanted extremity in the field of work had 95, and sport, music was assessed with a mean score of 96 points.
conclusionsSevere and disastrous combined and complex macroamputations of the upper extremity may also have an absolute indication for replantation even though the functional outcome is poor. Not only the feeling of physical integrity can be restored, but the replantation of an amputated upper extremity enables complete or partial recovery of function and sensibility of the arm which is important for the individual. Although our results show a very high DASH-Score, those achievements justify time and person consuming operations. In most cases a replanted extremity is still superior to a secondary allotransplantation. Usually the use of prosthesis is not favored by the treated patients.
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