title: The role of elective amputation in patients with traumatic brachial plexus injury.
abstract: OBJECTIVE
  Despite undergoing complex brachial plexus, surgical reconstructions, and rehabilitation, some patients request an elective amputation. This study evaluates the role of elective amputation after brachial plexus injury.
  
  
  METHODS
  A retrospective chart review was performed for all the 2140 patients with brachial plexus injuries treated with elective amputation between 1999 and 2012 at a single institution. Analysis was conducted on the potential predisposing factors for amputation, amputation level, and postamputation complications. Patients were evaluated using pre- and postamputation Disabilities of the Shoulder, Arm, and hand scores in addition to visual analog pain scores.
  
  
  RESULTS
  The following three conditions were observed in all nine patients who requested an elective amputation: (1) Pan-plexus injury; (2) non-recovery (mid-humeral amputation) or elbow flexion recovery only (forearm amputation) 1 year after all other surgical options were performed; and (3) at least one chronic complication (chronic infection, nonunion fractures, full-thickness burns, chronic neck pain with arm weight, etc.). Pain improvement was found in five patients. Subjective patient assessments and visual analog pain scores before and after amputation did not show a statistically significant improvement in Disabilities of the Shoulder, Arm, and Hand Scores. However, four patients reported that their shoulder pain felt "better" than it did before the amputation, and two patients indicated they were completely cured of chronic pain after surgery.
  
  
  CONCLUSIONS
  Elective amputation after brachial plexus injury should be considered as an option in the above circumstances. When the informed and educated decision is made, patients can have satisfactory outcomes regarding amputation.
authors.affiliation: Mayo Clinic, Department of Orthopedic Surgery, Division of Hand Surgery, 200 1st Street South West, Rochester, MN 55905, USA.
authors.forename: Andrés A
authors.initials: AA
authors.lastname: Maldonado
authors.affiliation: Mayo Clinic, Department of Orthopedic Surgery, Division of Hand Surgery, 200 1st Street South West, Rochester, MN 55905, USA.
authors.forename: Michelle F
authors.initials: MF
authors.lastname: Kircher
authors.affiliation: Mayo Clinic, Department of Neurologic Surgery and Department of Orthopedic Surgery, Division of Hand Surgery, 200 1st Street South West, Rochester, MN 55905, USA.
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Spinner
authors.affiliation: Mayo Clinic, Department of Orthopedic Surgery, Division of Hand Surgery, 200 1st Street South West, Rochester, MN 55905, USA.
authors.forename: Allen T
authors.initials: AT
authors.lastname: Bishop
authors.affiliation: Mayo Clinic, Department of Orthopedic Surgery, Division of Hand Surgery, 200 1st Street South West, Rochester, MN 55905, USA. Electronic address: shin.alexander@mayo.edu.
authors.forename: Alexander Y
authors.initials: AY
authors.lastname: Shin
mesh_terms: D000328:Adult; D000671:Amputation, Surgical / Q000379:methods*; D001132:Arm / Q000601:surgery*; D001917:Brachial Plexus / Q000293:injuries* / Q000601:surgery; D015331:Cohort Studies; D004185:Disability Evaluation; D017558:Elective Surgical Procedures / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D057240:Patient Preference / Q000706:statistics & numerical data; D059348:Peripheral Nerve Injuries / Q000601:surgery*; D019651:Plastic Surgery Procedures / Q000009:adverse effects / Q000379:methods*; D012189:Retrospective Studies; D018570:Risk Assessment; D012380:Role; D016896:Treatment Outcome; D014481:United States
keywords: Brachial plexus injuries; Elective amputation; Upper extremity injury; Upper limb amputation