[Failure of upper limb macro-implantations: surgery and outcome. 11 cases].
The failure of macro-implantation of the upper limb must not be considered as the end of a therapeutic method, but instead as a step in the functional rehabilitation of the upper limb. From a group of 24 patients that have been operated with a macro-implantation of the upper limb, we have seen 11 patients for who the reimplantation had failed. We have studied the surgical procedure of those failures, the mid-term evolution (prosthesis and operations), and a long-term evolution with the functional future of those patients. A surgical procedure with latissimus dorsi flap was necessary in six cases, in one hand to maintain a sufficient length of the stump for prosthesis and the other hand to preserve the articulation of the elbow. Nine patients on 11 were able to be "apparated" by a myoelectric prosthesis for the amputation below the elbow (seven cases), by prosthesis for the amputation above the elbow (two cases). On a long period of time (average time 51 months) only four patients had a permanent use of their prosthesis (myoelectric type). For us, the functional rehabilitation of the upper limb need two important elements: first a good quality of the stump with a sufficient length, and second an important motivation from the patient to live with his "new hand".
Houzé de l'Aulnoit
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ICARE, 467, avenue Maréchal Leclerc, 59155 Faches-Thumesnil, France.
Schoofs
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Leps
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Auvray
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D000328:Adult; D000368:Aged; D000673:Amputation, Traumatic / Q000534:rehabilitation / Q000601:surgery*; D001134:Arm Injuries / Q000534:rehabilitation / Q000601:surgery*; D001186:Artificial Limbs; D005260:Female; D005500:Follow-Up Studies; D005544:Forecasting; D006801:Humans; D008297:Male; D008866:Microsurgery / Q000379:methods*; D008875:Middle Aged; D012086:Reoperation; D012092:Replantation / Q000379:methods*; D012307:Risk Factors; D013524:Surgical Flaps / Q000639:trends; D013997:Time Factors; D017211:Treatment Failure