REPLANTATION AND REVASCULARIZATION AT THE TRANSMETACARPAL LEVEL - LONG-TERM FUNCTIONAL RESULTS

Thirteen consecutive transmetacarpal replantations and revascularizati ons in 12 patients were reviewed retrospectively. Ten patients (11 han ds) sustained crush injuries, 1 withstood an explosive blast, and 1 su ffered a guillotine amputation. Nine revascularizations (1 thumb and 3 1 fingers) and 4 replantations (1 thumb and 16 fingers), including bil ateral procedures in 1 patient, were performed. Forty-four of 49 repla ntable digits (90%) were salvaged. Ten patients (11 hands) required se condary surgery (mean, 4.5 procedures per hand), 29 of 49 (60%) for te ndon and joint scarring and 7 of 20 (14%) for nonunions or malunions. Range of motion averaged 109 degrees per digit. intrinsic muscle funct ion and pinch and grip strengths were weak or absent. Recovery of sens ibility was poor. According to Chen et al.'s grading system of functio nal return, 4 (31%) were grade 11, 4 (31%) were grade III, and 5 (38%) grade IV. The follow-up period ranged from 2.5 to 11 years. Only 1 pa tient resumed his prior occupation (as supervisor); 2 were permanently disabled, 3 pursued new and unrelated occupations, 2 were still in th erapy, and 4 were lost to late follow-up evaluation. None of the manua l laborers (11 patients) were able to return to their preinjury liveli hood. Despite these discouragingly poor results, all patients were sat isfied with the surgery.