title: [Long-term results of major upper extremity replantations].
abstract: OBJECTIVE
  The aim of this study was to evaluate long-term clinical and functional results of major upper extremity replantations.
  
  
  METHODS
  We retrospectively evaluated 26 male patients (mean age 27 years; range 3 to 69 years) who underwent major upper extremity replantations and had a mean follow-up of 11.3 years (range 5 to 19 years). The levels of the replantations were transmetacarpal (n=6), wrist (n=4), forearm (n=5), elbow (n=4), and arm (n=7). Amputations were of clean-cut, crush, and avulsion types in seven, eight, and 11 patients, respectively. Secondary operations were performed in 19 patients. Functional results were assessed using the Chen's criteria and the Turkish version of the DASH questionnaire (Disabilities of the Arm, Shoulder and Hand) was administered.
  
  
  RESULTS
  The mean surgical shortening was 37.2 mm, and the final mean radiographic shortening was 52.2 mm. The mean grip and pinch strengths on the affected side were 12.3 kg and 3.6 kg, compared to the strengths of 37.6 kg and 8.7 kg on the normal side, respectively. Monofilament testing showed sensory recovery in 20 patients. Two-point discrimination could be made by 18 patients for the median nerve, and by 17 patients for the ulnar nerve. According to the Chen's criteria, the results were very good or good in 17 patients (65.4%), moderate in three patients (11.5%), and poor in six patients (23.1%). Functional results were correlated with the level (r=0.71) and type (r=0.65) of injury, with injuries at the elbow level and avulsion injuries being associated with a worse outcome. The mean DASH score was 6.7 (range 0 to 32.5) and the mean scores of Chen's grade I-II and grade III-IV patients differed significantly (p<0.05).
  
  
  CONCLUSIONS
  Lower DASH scores show increased satisfaction of the patients and improved use of their replanted extremities as the helper arm whereby functional deficiency is somewhat compensated.
authors.affiliation: Hand Microsurgery Orthopedics and Traumatology Hospital, 35230 Kahramanlar, Izmir, Turkey.
authors.forename: Tahir Sadik
authors.initials: TS
authors.lastname: Sugun
authors.forename: Kemal
authors.initials: K
authors.lastname: Ozaksar
authors.forename: Sait
authors.initials: S
authors.lastname: Ada
authors.forename: Firdevs
authors.initials: F
authors.lastname: Kul
authors.forename: Fuat
authors.initials: F
authors.lastname: Ozerkan
authors.forename: Ibrahim
authors.initials: I
authors.lastname: Kaplan
authors.forename: Yalcin
authors.initials: Y
authors.lastname: Ademohlu
authors.forename: Murat
authors.initials: M
authors.lastname: Kayalar
authors.forename: Emin
authors.initials: E
authors.lastname: Bal
authors.forename: Tulgar
authors.initials: T
authors.lastname: Toros
authors.forename: Aslan
authors.initials: A
authors.lastname: Bora
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000671:Amputation, Surgical / Q000379:methods*; D000673:Amputation, Traumatic / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D005383:Finger Injuries / Q000601:surgery*; D005500:Follow-Up Studies; D006225:Hand / Q000601:surgery*; D006230:Hand Injuries / Q000601:surgery*; D006801:Humans; D008297:Male; D008866:Microsurgery; D008875:Middle Aged; D011379:Prognosis; D016059:Range of Motion, Articular; D019651:Plastic Surgery Procedures; D012092:Replantation / Q000379:methods*; D012189:Retrospective Studies; D034941:Upper Extremity / Q000293:injuries / Q000601:surgery; D055815:Young Adult