Replantation versus Prosthetic Fitting in Traumatic Arm Amputations: A Systematic Review.
BACKGROUND
Traumatic arm amputations can be treated with replantation or surgical formalization of the stump with or without subsequent prosthetic fitting. In the literature, many authors suggest the superiority of replantation. This systematic review compared available literature to analyze whether replantation is functionally and psychologically more profitable than formalization and prosthetic fitting in patients with traumatic arm amputation.


METHODS
Functional outcome and satisfaction levels were recorded of patients with amputation levels below elbow, through elbow, and above elbow.


RESULTS
Functional outcomes of 301 replantation patients and 172 prosthesis patients were obtained. In the replantation group, good or excellent functional scores were reported in 39% of above elbow, 55% of through elbow, and 50% of below elbow amputation cases. Nearly 100% of patients were satisfied with the replanted limb. In the prosthesis group, full use of the prosthesis was attained in 48% of above elbow and in 89% of below elbow amputation patients. Here, 29% of patients elected not to use the prosthesis for reasons including pain and functional superfluity. In both replantation patients and prosthesis wearers, a below elbow amputation yielded better functional results than higher amputation levels.


CONCLUSIONS
Replantation of a traumatically amputated arm leads to good function and higher satisfaction rates than a prosthesis, regardless of the objective functional outcome. Sensation and psychological well-being seem the two major advantages of replantation over a prosthesis. The current review of the available literature shows that in carefully selected cases replantation could be the preferred option of treatment.
Department of Plastic, Reconstructive and Hand Surgery, University Medical Center Utrecht, Utrecht, The Netherlands.
Iris A
IA
Otto
Department of Plastic, Reconstructive and Hand Surgery, University Medical Center Utrecht, Utrecht, The Netherlands.
Moshe
M
Kon
Department of Plastic, Reconstructive and Hand Surgery, University Medical Center Utrecht, Utrecht, The Netherlands; The Hand Clinic, Amsterdam, The Netherlands.
Arnold H
AH
Schuurman
Department of Plastic, Reconstructive and Hand Surgery, University Medical Center Utrecht, Utrecht, The Netherlands.
L Paul
LP
van Minnen
D000293:Adolescent; D000328:Adult; D000368:Aged; D000673:Amputation, Traumatic / Q000523:psychology / Q000534:rehabilitation* / Q000601:surgery; D001132:Arm / Q000601:surgery; D001134:Arm Injuries / Q000523:psychology / Q000534:rehabilitation* / Q000601:surgery; D001186:Artificial Limbs / Q000523:psychology*; D002648:Child; D002675:Child, Preschool; D004551:Elbow Joint / Q000601:surgery; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction / Q000706:statistics & numerical data; D011788:Quality of Life / Q000523:psychology*; D016896:Treatment Outcome; D000092464:Elbow Injuries