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Classification and evaluation of the functional results of replanted parts of the hand at the Prince of Wales Hospital and the Prince of Wales Children's Hospital: 1984 to 1988

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Abstract

This paper describes a simple method of classification and evaluation of the functional results of replanted and revascularized parts in the hand. The results are presented in graphic form and have been analyzed to correlate various factors: injured part, cause, and zone (level) of injury. The type of injury, ischemic time and age have been studied in more detail to determine their influence of the final functional result. The series contains 187 amputated and devascularized parts of the hand in 119 patients who have undergone surgery at the Prince of Wales Hospital from 1984 through 1988. The length of cold or warm ischemic times, up to 16 hours in this series, while not affecting survival of the amputated part, does adversely affect the functional result. The survival rate of replanted parts in children was significantly less favorable than in adults, but the functional results were uniformly superior.

Résumé

Cet article décrit une méthode simple de classification et d'évaluation des résultats fonctionnels des structures de la main réimplantées ou revascularisées en urgence. Les résultats sont présentés sous forme de graphique et ont été analysés pour établir une corrélation des facteurs suivants: partie lésée, cause, niveau de la lésion. Ont été étudiés plus en détail le type de lésion, le temps d'ischemic et l'âge du patient por déterminer leur influence sur les résultats. Cette série concerne 187 amputations ou cas de dévascularisations de la main chez 119 patients tous traités à l'Hôpital Prince of Wales entre 1984 et 1988. Il existe des indices que la durée de l'ischémie chaude ou froide, jusqu'à 16 heures dans cette série, influence de façon négative le résultat fonctionnel, indépendemment des possibilités de survie de la ré implantation. Le taux de survie des amputations réimplantées chez l'enfant est inférieur à celui des amputations réimplantées chez l'adulte, mais les résultats fonctionnels sont infiniment supérieurs.

Resumen

El presente trabajo describe un método simple de clasificación y evaluatión de los resultados funcionales de partes reimplantadas y revascularizadas de la mano. Los resulados, que se presentan en forma gráfica, fueron analizados para correlacionar diversos factores: la parte lesionada, la causa y la zona (o nivel) de la lesión. El tipo de la lesión, la hora y la duración de la isquemia fueron estudiados en mayor detalle para determinar su influencia sobre el resultado funcional final. La serie está conformada por 187 partes amputadas y devascularizadas de la mano en 119 pacientes sometidos a cirugía en el Hospital Príncipe de Gales entre 1984 y 1988. Los resultados de este estudio indican que el tiempo de isquemia, fría o caliente hasta 16 horas, aunque no afecta la supervivencia de la parte afectada, sí afecta en forma adversa el resultado funcional. La tasa de supervivencia de las partes reimplatadas en niños apareció significativamente menos favorable que en los adultos, pero los resultados funcionales fueron uniformemente superiores.

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Authors and Affiliations

  1. Department of Plastic and Reconstructive Surgery, The Prince of Wales Hospital, Sydney, Australia

    Barrie C. Milroy M.B., B.S. (Lond), F.R.A.C.S., Richard P. Sackelariou M.B., B.S. (Syd), F.R.C.S., F.R.A.C.S., Paul G. Lendvay M.B., B.S., F.R.C.S., F.R.A.C.S., Michael R. A. Baldwin M.B., B.S., F.R.A.C.S. & Michael McGlynn M.B., B.S., F.R.A.C.S.

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  1. Barrie C. Milroy M.B., B.S. (Lond), F.R.A.C.S.
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  2. Richard P. Sackelariou M.B., B.S. (Syd), F.R.C.S., F.R.A.C.S.
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  3. Paul G. Lendvay M.B., B.S., F.R.C.S., F.R.A.C.S.
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  4. Michael R. A. Baldwin M.B., B.S., F.R.A.C.S.
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  5. Michael McGlynn M.B., B.S., F.R.A.C.S.
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Milroy, B.C., Sackelariou, R.P., Lendvay, P.G. et al. Classification and evaluation of the functional results of replanted parts of the hand at the Prince of Wales Hospital and the Prince of Wales Children's Hospital: 1984 to 1988. World J. Surg. 15, 446–451 (1991). https://doi.org/10.1007/BF01675639

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