title: Comparison of patient-reported outcomes after traumatic upper extremity amputation: Replantation versus prosthetic rehabilitation.
abstract: BACKGROUND
  After major upper extremity traumatic amputation, replantation is attempted based upon the assumption that outcomes for a replanted limb exceed those for revision amputation with prosthetic rehabilitation. While some reports have examined functional differences between these patients, it is increasingly apparent that patient perceptions are also critical determinants of success. Currently, little patient-reported outcomes data exists to support surgical decision-making in the setting of major upper extremity traumatic amputation. Therefore, the purpose of this study is to directly compare patient-reported outcomes after replantation versus prosthetic rehabilitation.
  
  
  METHODS
  At three tertiary care centers, patients with a history of traumatic unilateral upper extremity amputation at or between the radiocarpal and elbow joints were identified. Patients who underwent either successful replantation or revision amputation with prosthetic rehabilitation were contacted. Patient-reported health status was evaluated with both DASH and MHQ instruments. Intergroup comparisons were performed for aggregate DASH score, aggregate MHQ score on the injured side, and each MHQ domain.
  
  
  RESULTS
  Nine patients with successful replantation and 22 amputees who underwent prosthetic rehabilitation were enrolled. Aggregate MHQ score for the affected extremity was significantly higher for the Replantation group compared to the Prosthetic Rehabilitation group (47.2 vs. 35.1, p<0.05). Among the MHQ domains, significant advantages to replantation were demonstrated with respect to overall function (41.1 vs. 19.7, p=0.03), ADLs (28.3 vs. 6.0, p=0.03), and patient satisfaction (46.0 vs. 24.4, p=0.03). Additionally, Replantation patients had a lower mean DASH score (24.6 vs. 39.8, p=0.08).
  
  
  CONCLUSIONS
  Patients in this study who experienced major upper extremity traumatic amputation reported more favorable patient-reported outcomes after successful replantation compared to revision amputation with prosthetic rehabilitation.
authors.affiliation: Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Washington Medical Center, Seattle, WA, United States.
authors.forename: Mitchell A
authors.initials: MA
authors.lastname: Pet
authors.affiliation: Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Washington Medical Center, Seattle, WA, United States.
authors.forename: Shane D
authors.initials: SD
authors.lastname: Morrison
authors.affiliation: Section of Plastic and Reconstructive Surgery, Department of Surgery, University of Michigan Health System, Ann Arbor, MI, United States.
authors.forename: Jacob S
authors.initials: JS
authors.lastname: Mack
authors.affiliation: Section of Plastic and Reconstructive Surgery, Department of Surgery, University of Michigan Health System, Ann Arbor, MI, United States.
authors.forename: Erika D
authors.initials: ED
authors.lastname: Sears
authors.affiliation: Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Washington Medical Center, Seattle, WA, United States.
authors.forename: Thomas
authors.initials: T
authors.lastname: Wright
authors.affiliation: Section of Plastic and Reconstructive Surgery, Department of Surgery, University of Michigan Health System, Ann Arbor, MI, United States.
authors.forename: Alisha D
authors.initials: AD
authors.lastname: Lussiez
authors.affiliation: Curtis National Hand Center, MedStar Union Memorial Hospital, Baltimore, MD, United States.
authors.forename: Kenneth R
authors.initials: KR
authors.lastname: Means
authors.affiliation: Curtis National Hand Center, MedStar Union Memorial Hospital, Baltimore, MD, United States.
authors.forename: James P
authors.initials: JP
authors.lastname: Higgins
authors.affiliation: Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Washington Medical Center, Seattle, WA, United States.
authors.forename: Jason H
authors.initials: JH
authors.lastname: Ko
authors.affiliation: Section of Plastic and Reconstructive Surgery, Department of Surgery, University of Michigan Health System, Ann Arbor, MI, United States.
authors.forename: Paul S
authors.initials: PS
authors.lastname: Cederna
authors.affiliation: Section of Plastic and Reconstructive Surgery, Department of Surgery, University of Michigan Health System, Ann Arbor, MI, United States. Electronic address: thekung@umich.edu.
authors.forename: Theodore A
authors.initials: TA
authors.lastname: Kung
mesh_terms: D000203:Activities of Daily Living; D000328:Adult; D000673:Amputation, Traumatic / Q000503:physiopathology* / Q000534:rehabilitation / Q000601:surgery; D000674:Amputees / Q000523:psychology / Q000534:rehabilitation*; D001134:Arm Injuries / Q000503:physiopathology* / Q000534:rehabilitation / Q000601:surgery; D001186:Artificial Limbs; D005260:Female; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D008875:Middle Aged; D000071066:Patient Reported Outcome Measures; D017060:Patient Satisfaction; D012092:Replantation / Q000523:psychology / Q000534:rehabilitation*; D012189:Retrospective Studies; D062707:Return to Work / Q000706:statistics & numerical data; D016896:Treatment Outcome; D014481:United States
keywords: Amputation; DASH; MHQ; Patient-reported outcomes; Prosthetic rehabilitation; Replantation; Upper extremity