title: Hay baler injuries to the upper extremity.
abstract: BACKGROUND
  Hay baler injuries to the upper extremity have not been well documented in the medical literature. In this series, we analyze the functional results of reconstruction, replantation, or amputation in relation to the severity of the injury.
  
  
  METHODS
  Twenty-one patients treated after a hay baler injury to an upper extremity were included in the study. Mean follow-up was 30.6 months. Patients were categorized into five different groups according to the anatomic location of injury, the presence of vascularity, and the severity of tissue injury: (1) single digit injury, (2) viable hand with limited tissue loss, (3) viable hand with extensive tissue loss, (4) amputation or devascularization with limited tissue loss, or (5) amputation or devascularization with extensive tissue loss. The functional results were assessed based on the usefulness of the injured extremity.
  
  
  RESULTS
  Patients underwent an average of three operative procedures and 11.5 days of hospitalization. The overall infection rate was 33%. Eleven patients had good functional results, four had fair results, and six had poor results. Higher infection rates, increased number of operative procedures, prolonged hospital stays, and poor functional scores correlated with the increased severity of the injury.
  
  
  CONCLUSIONS
  The degree of initial tissue loss seemed to correlate with both the ability to replant the extremity and the functional outcome of the reconstruction. Free tissue transfers or replantation improved results in selected cases. All patients in this series who underwent replantation and concurrent free tissue transfer ultimately obligated a revision amputation.
authors.affiliation: Division of Hand Surgery, Department of Surgery, University of Louisville, School of Medicine, and Christine M. Kleinert Institute for Hand and Microsurgery, Louisville, Kentucky 40202, USA. tozyurekoglu@kkahand.com
authors.forename: Tuna
authors.initials: T
authors.lastname: Ozyürekoğlu
authors.forename: Margaret
authors.initials: M
authors.lastname: Napolitano
authors.forename: James M
authors.initials: JM
authors.lastname: Kleinert
mesh_terms: D000062:Accidents, Occupational; D000293:Adolescent; D000328:Adult; D000368:Aged; D000383:Agriculture; D000465:Algorithms; D000673:Amputation, Traumatic / Q000209:etiology / Q000601:surgery*; D019072:Antibiotic Prophylaxis; D001134:Arm Injuries / Q000150:complications / Q000209:etiology / Q000601:surgery*; D002648:Child; D003646:Debridement; D005383:Finger Injuries / Q000209:etiology / Q000601:surgery; D006801:Humans; D007902:Length of Stay; D008875:Middle Aged; D019637:Orthopedic Procedures / Q000706:statistics & numerical data; D012086:Reoperation; D012092:Replantation; D017695:Soft Tissue Injuries / Q000209:etiology / Q000601:surgery; D016896:Treatment Outcome; D014946:Wound Infection / Q000453:epidemiology / Q000517:prevention & control