Retrospective Review of Air Transportation Use for Upper Extremity Amputations at a Level-1 Trauma Center.
BACKGROUND
Air transportation to tertiary care centers of patients with upper extremity amputations has been utilized in hopes of reducing the time to potential replantation; however, this mode of transportation is expensive and not all patients will undergo replantation. The purpose of this study is to review the appropriateness and cost of air transportation in upper extremity amputations.


METHODS
Consecutive patients transported by aircraft with upper extremity amputations in a 7-year period at a level-1 trauma center were retrospectively reviewed. The distance traveled was recorded, along with the times of the injury, referral, transportation duration, arrival, and start of the operation. The results of the transfer were defined as replantation or revision amputation.


RESULTS
Overall, 47 patients were identified with 43 patients going to the operating room, but only 14 patients (30%) undergoing replantation. Patients arrived at the tertiary hand surgery center with a mean time of 182.3 minutes following the injury, which includes 105.2 minutes of transportation time. The average distance traveled was 105.4 miles (range, 22-353 miles). The time before surgery of those who underwent replantation was 154.6 minutes. The average cost of transportation was $20,482.


CONCLUSIONS
Air transportation for isolated upper extremity amputations is costly and is not usually the determining factor for replantation. The type of injury and patients' expectations often dictate the outcome, and these may be better determined at the time of referral with use of telecommunication photos, discussion with a hand surgeon, and patient counseling.


METHODS
III.
Vanderbilt University Medical Center, Vanderbilt Orthopaedic Institute, Nashville, Tennessee, United States.
W Jeffrey
WJ
Grantham
OrthoArizona, Scottsdale, Arizona, United States.
Philip
P
To
Colorado Springs Orthopaedic Group, Colorado Springs, Colorado, United States.
Jeffry T
JT
Watson
Vanderbilt Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, United States.
Jeremy
J
Brywczynski
Vanderbilt University Medical Center, Vanderbilt Orthopaedic Institute, Nashville, Tennessee, United States.
Donald H
DH
Lee
air transport; digit amputation; replantation; upper extremity amputation