title: Disability and health after replantation or revascularisation in the upper extremity in a population in southern Sweden - a retrospective long time follow up.
abstract: BACKGROUND
  Replantation in the upper extremity is a well-established microsurgical procedure. Many have reported patients' satisfaction and functional measurements.The aim was to investigate the long time consequences as activity limitations in hand/arm, the general health and cold sensitivity after a replantation or revascularization in the upper extremity and to examine if sense of coherence (SOC) can be an indicator for rehabilitation focus.
  
  
  METHODS
  Between 1994-2008, 326 patients needed replantation/revascularization in the upper extremity. 297 patients were followed up. Information was collected from the medical notes and by questionnaires [Quick-DASH (disability hand/arm), EuroQ-5D (general health), CISS (cold sensitivity) and SOC (sense of coherence)]. Severity of injury was classified with the modified Hand Injury Severity Score (MHISS).
  
  
  RESULTS
  The patients [272 (84%) men and 54 (16%) women; median age 39 years (1-81 years)], where most injuries affected fingers (63%) and thumb (25%), commonly affecting the proximal phalanx (43%). The injuries were commonly related to saws (22%), machines (20%) and wood splints (20%). A direct anastomosis (30%) or vein grafts (70%) were used. The overall survival was 90%. 59% were classified as Major.Equal parts of the injuries took part during work and leisure, DASH scores at follow up were worse (p = 0.005) in the former. Twenty percent changed work and 10% retired early. Patients with early retirement were significantly older, had a more severe injury, worse disability, quality of life and functional outcome. Median DASH score was low [11.4 (0-88.6)] and correlated with severity of injury. Abnormal cold sensitivity (CISS > 50) was seen in 51/209 (24%) and they had a worse disability, quality of life, functional outcome and lower SOC. Patients with a low SOC had on the whole a worse outcome compared to patients with a high SOC and with significant differences in age, EQ-5D, Quick-DASH and CISS.
  
  
  CONCLUSIONS
  A high MHISS, abnormal cold intolerance and a low SOC seems to be factors influencing the patients' outcome and might be relevant in the rehabilitation of the patients. Also, those who had to retire early had a worse disability, quality of life and functional outcome.
authors.affiliation: Department of Clinical Sciences Malmö - Hand Surgery, Skåne University Hospital, Lund University, 205 02 Malmö, Sweden. hanse.rosberg@med.lu.se.
authors.forename: Hans-Eric
authors.initials: HE
authors.lastname: Rosberg
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000673:Amputation, Traumatic / Q000601:surgery*; D000714:Anastomosis, Surgical; D002648:Child; D002675:Child, Preschool; D003080:Cold Temperature / Q000009:adverse effects; D004185:Disability Evaluation; D005260:Female; D005500:Follow-Up Studies; D006225:Hand / Q000098:blood supply* / Q000601:surgery; D006230:Hand Injuries / Q000534:rehabilitation / Q000601:surgery*; D006801:Humans; D006941:Hyperesthesia / Q000209:etiology / Q000523:psychology; D007223:Infant; D008297:Male; D008866:Microsurgery; D008875:Middle Aged; D060051:Occupational Injuries / Q000534:rehabilitation / Q000601:surgery; D011183:Postoperative Complications / Q000453:epidemiology / Q000523:psychology; D011788:Quality of Life; D020127:Recovery of Function; D012092:Replantation; D012189:Retrospective Studies; D011795:Surveys and Questionnaires; D013548:Sweden / Q000453:epidemiology; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000534:rehabilitation; D014680:Veins / Q000637:transplantation; D055815:Young Adult