Comparison of patient-reported outcomes after traumatic upper extremity amputation: Replantation versus prosthetic rehabilitation

Mitchell A Pet; Shane D Morrison; Jacob S Mack; Erika D Sears; Thomas Wright; Alisha D Lussiez; Kenneth R Means; James P Higgins; Jason H Ko; Paul S Cederna; Theodore A Kung

doi:10.1016/j.injury.2016.10.004

Comparison of patient-reported outcomes after traumatic upper extremity amputation: Replantation versus prosthetic rehabilitation

Injury. 2016 Dec;47(12):2783-2788. doi: 10.1016/j.injury.2016.10.004. Epub 2016 Oct 19.

Authors

Affiliations

¹ Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Washington Medical Center, Seattle, WA, United States.
² Section of Plastic and Reconstructive Surgery, Department of Surgery, University of Michigan Health System, Ann Arbor, MI, United States.
³ Curtis National Hand Center, MedStar Union Memorial Hospital, Baltimore, MD, United States.
⁴ Section of Plastic and Reconstructive Surgery, Department of Surgery, University of Michigan Health System, Ann Arbor, MI, United States. Electronic address: thekung@umich.edu.

PMID: 28029356
DOI: 10.1016/j.injury.2016.10.004

Abstract

Background: After major upper extremity traumatic amputation, replantation is attempted based upon the assumption that outcomes for a replanted limb exceed those for revision amputation with prosthetic rehabilitation. While some reports have examined functional differences between these patients, it is increasingly apparent that patient perceptions are also critical determinants of success. Currently, little patient-reported outcomes data exists to support surgical decision-making in the setting of major upper extremity traumatic amputation. Therefore, the purpose of this study is to directly compare patient-reported outcomes after replantation versus prosthetic rehabilitation.

Methods: At three tertiary care centers, patients with a history of traumatic unilateral upper extremity amputation at or between the radiocarpal and elbow joints were identified. Patients who underwent either successful replantation or revision amputation with prosthetic rehabilitation were contacted. Patient-reported health status was evaluated with both DASH and MHQ instruments. Intergroup comparisons were performed for aggregate DASH score, aggregate MHQ score on the injured side, and each MHQ domain.

Results: Nine patients with successful replantation and 22 amputees who underwent prosthetic rehabilitation were enrolled. Aggregate MHQ score for the affected extremity was significantly higher for the Replantation group compared to the Prosthetic Rehabilitation group (47.2 vs. 35.1, p<0.05). Among the MHQ domains, significant advantages to replantation were demonstrated with respect to overall function (41.1 vs. 19.7, p=0.03), ADLs (28.3 vs. 6.0, p=0.03), and patient satisfaction (46.0 vs. 24.4, p=0.03). Additionally, Replantation patients had a lower mean DASH score (24.6 vs. 39.8, p=0.08).

Conclusions: Patients in this study who experienced major upper extremity traumatic amputation reported more favorable patient-reported outcomes after successful replantation compared to revision amputation with prosthetic rehabilitation.

Keywords: Amputation; DASH; MHQ; Patient-reported outcomes; Prosthetic rehabilitation; Replantation; Upper extremity.

Publication types

Comparative Study

MeSH terms

Activities of Daily Living
Adult
Amputation, Traumatic / physiopathology*
Amputation, Traumatic / rehabilitation
Amputation, Traumatic / surgery
Amputees / psychology
Amputees / rehabilitation*
Arm Injuries / physiopathology*
Arm Injuries / rehabilitation
Arm Injuries / surgery
Artificial Limbs*
Female
Humans
Injury Severity Score
Male
Middle Aged
Patient Reported Outcome Measures
Patient Satisfaction
Replantation / psychology
Replantation / rehabilitation*
Retrospective Studies
Return to Work / statistics & numerical data
Treatment Outcome
United States