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Major replantation versus revision amputation and prosthetic fitting in the upper extremity: A late functional outcomes study

  • Author Footnotes
    1 From the Divisions of Orthopaedic and Plastic Surgery, University of Toronto, Toronto, Ontario; the Kleinert, Kutz and Associates Hand Care Center, Louisville, KY; the Department of Surgery, University of Louisville, Louisville, KY; the Christine M. Kleinert Institute for Hand and Microsurgery, and the Departments of Physiology and Biophysics and Surgery, University of Louisville, Louisville, KY.
    Brent Graham
    Footnotes
    1 From the Divisions of Orthopaedic and Plastic Surgery, University of Toronto, Toronto, Ontario; the Kleinert, Kutz and Associates Hand Care Center, Louisville, KY; the Department of Surgery, University of Louisville, Louisville, KY; the Christine M. Kleinert Institute for Hand and Microsurgery, and the Departments of Physiology and Biophysics and Surgery, University of Louisville, Louisville, KY.
    Affiliations
    Toronto, Ontario, Canada
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  • Author Footnotes
    1 From the Divisions of Orthopaedic and Plastic Surgery, University of Toronto, Toronto, Ontario; the Kleinert, Kutz and Associates Hand Care Center, Louisville, KY; the Department of Surgery, University of Louisville, Louisville, KY; the Christine M. Kleinert Institute for Hand and Microsurgery, and the Departments of Physiology and Biophysics and Surgery, University of Louisville, Louisville, KY.
    Paula Adkins
    Footnotes
    1 From the Divisions of Orthopaedic and Plastic Surgery, University of Toronto, Toronto, Ontario; the Kleinert, Kutz and Associates Hand Care Center, Louisville, KY; the Department of Surgery, University of Louisville, Louisville, KY; the Christine M. Kleinert Institute for Hand and Microsurgery, and the Departments of Physiology and Biophysics and Surgery, University of Louisville, Louisville, KY.
    Affiliations
    Louisville, KY, USA
    Search for articles by this author
  • Author Footnotes
    1 From the Divisions of Orthopaedic and Plastic Surgery, University of Toronto, Toronto, Ontario; the Kleinert, Kutz and Associates Hand Care Center, Louisville, KY; the Department of Surgery, University of Louisville, Louisville, KY; the Christine M. Kleinert Institute for Hand and Microsurgery, and the Departments of Physiology and Biophysics and Surgery, University of Louisville, Louisville, KY.
    Tsu-Min Tsai
    Footnotes
    1 From the Divisions of Orthopaedic and Plastic Surgery, University of Toronto, Toronto, Ontario; the Kleinert, Kutz and Associates Hand Care Center, Louisville, KY; the Department of Surgery, University of Louisville, Louisville, KY; the Christine M. Kleinert Institute for Hand and Microsurgery, and the Departments of Physiology and Biophysics and Surgery, University of Louisville, Louisville, KY.
    Affiliations
    Louisville, KY, USA
    Search for articles by this author
  • Author Footnotes
    1 From the Divisions of Orthopaedic and Plastic Surgery, University of Toronto, Toronto, Ontario; the Kleinert, Kutz and Associates Hand Care Center, Louisville, KY; the Department of Surgery, University of Louisville, Louisville, KY; the Christine M. Kleinert Institute for Hand and Microsurgery, and the Departments of Physiology and Biophysics and Surgery, University of Louisville, Louisville, KY.
    John Firrell
    Footnotes
    1 From the Divisions of Orthopaedic and Plastic Surgery, University of Toronto, Toronto, Ontario; the Kleinert, Kutz and Associates Hand Care Center, Louisville, KY; the Department of Surgery, University of Louisville, Louisville, KY; the Christine M. Kleinert Institute for Hand and Microsurgery, and the Departments of Physiology and Biophysics and Surgery, University of Louisville, Louisville, KY.
    Affiliations
    Louisville, KY, USA
    Search for articles by this author
  • Author Footnotes
    1 From the Divisions of Orthopaedic and Plastic Surgery, University of Toronto, Toronto, Ontario; the Kleinert, Kutz and Associates Hand Care Center, Louisville, KY; the Department of Surgery, University of Louisville, Louisville, KY; the Christine M. Kleinert Institute for Hand and Microsurgery, and the Departments of Physiology and Biophysics and Surgery, University of Louisville, Louisville, KY.
    Warren C. Breidenvach
    Correspondence
    Reprint requests: Warren C. Breidenbach, MD, Christine Kleinert Institute for Hand and Microsurgery, Suite 810, 225 Abraham Flexner Way, Louisville, KY 40202.
    Footnotes
    1 From the Divisions of Orthopaedic and Plastic Surgery, University of Toronto, Toronto, Ontario; the Kleinert, Kutz and Associates Hand Care Center, Louisville, KY; the Department of Surgery, University of Louisville, Louisville, KY; the Christine M. Kleinert Institute for Hand and Microsurgery, and the Departments of Physiology and Biophysics and Surgery, University of Louisville, Louisville, KY.
    Affiliations
    Louisville, KY, USA
    Search for articles by this author
  • Author Footnotes
    1 From the Divisions of Orthopaedic and Plastic Surgery, University of Toronto, Toronto, Ontario; the Kleinert, Kutz and Associates Hand Care Center, Louisville, KY; the Department of Surgery, University of Louisville, Louisville, KY; the Christine M. Kleinert Institute for Hand and Microsurgery, and the Departments of Physiology and Biophysics and Surgery, University of Louisville, Louisville, KY.
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      The functional outcomes of amputated arms that were either replanted or had a prosthesis were compared. In addition, factors that influenced the functional outcome of replants were evaluated. The Carroll test was used to evaluate functional capacity of 22 successful upper extremity replantations at or proximal to the wrist as well as 22 amputees (at similar levels) fitted with a variety of prosthetic devices. The outcome was excellent or good in 8 (36%) replanted limbs. This proportion was statistically higher than those grades in the prosthetic group. When the groups were more closely matched (adults with below elbow injuries), the replantation group had 6 (50%) good or excellent outcomes and the prosthetic group had none. An analysis of covariance of the replatations demonstrated a statistical association between a better outcome in younger patients with more distal injuries. This study indicates that replantation produces superior functional results compared with amputation and a prosthesis.
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