Research Article| Volume 60, ISSUE 4, P339-348, April 2007

Long-term functional results of primary reconstruction of severe forearm injuries

Published:January 22, 2007DOI:


      Severe forearm injuries caused by machinery such as a power saw represented about 0.2% of all upper limb injuries operated on in the plastic surgery section of our institute between 1993 and 1997. These are complex and contaminated injuries with severe damage to skin, muscles, tendons, nerves, vessels and bones. Primary repair or reconstruction of all the divided vital structures was carried out in our series of four patients, including one 4-cm cable nerve graft for a median nerve defect. After an average 22-month follow up, the functional results showed grade M4 motor recovery and better than grade S3+ sensory recovery of the hand in all four patients. We suggest that a definitive primary procedure is best when possible. This will achieve a better functional outcome from early neural regeneration, and will reduce the frequency of secondary procedures, cause less scarring, and shorten the duration of hospital stays and rehabilitation periods.


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        • Kreiger N.
        • Kelsey J.L.
        • Harris C.
        • et al.
        Injuries to the upper extremity: pattern of occurrence.
        Clin Plast Surg. 1981; 8: 13-19
        • Brown P.W.
        Open injuries of the hand.
        in: Green D.P. Green's operative hand surgery. 4th ed. Churchill Livingstone, New York1999: 1607-1630
        • Faibisoff B.
        • Daniel R.K.
        Management of severe forearm injuries.
        Surg Clin North Am. 1981; 61: 287-301
        • Carter P.R.
        Crush injury of the upper limb. Early and late management.
        Orthop Clin North Am. 1983; 14: 719-747
        • Shieh S.J.
        • Chiu H.Y.
        • Lee J.W.
        • et al.
        Functional results of digital replantation and revascularization.
        J Plast Reconstr Surg Assoc (ROC). 1994; 3: 4-11
        • Johansen K.
        • Daines M.
        • Howey T.
        • et al.
        Objective criteria accurately predict amputation following lower extremity trauma.
        J Trauma. 1990; 30: 568-573
        • Slauterbeck J.R.
        • Britton C.
        • Moneim M.S.
        • et al.
        Mangled extremity severity score: an accurate guide to treatment of the severely injured upper extremity.
        J Orthop Trauma. 1994; 8: 282-285
        • Hsu H.Y.
        • Chiu H.Y.
        • Shieh S.J.
        • et al.
        The rehabilitation protocol of digital replantation.
        J Occup Ther Assoc (ROC). 1994; 12: 85-93
        • Dellon A.L.
        • Curtis R.M.
        • Edgerton M.T.
        Reeducation of sensation in the hand after nerve injury and repair.
        Plast Reconstr Surg. 1974; 53: 297-305
        • Gregory R.T.
        • Gould R.J.
        • Peclet M.
        • et al.
        The mangled extremity syndrome (M.E.S.): a severity grading system for multisystem injury of the extremity.
        J Trauma. 1985; 25: 1147-1150
        • Jabaley M.E.
        • Peterson H.D.
        Early treatment of war wounds of the hand and forearm in Vietnam.
        Ann Surg. 1973; 177: 167-173
        • Goldner R.D.
        • Nunley J.A.
        Replantation proximal to wrist.
        Hand Clin. 1992; 8: 413-425
        • Riska E.B.
        • Bonsdorff H.V.
        • Hakkinen S.
        • et al.
        Primary operative fixation of long bone fractures in patients with multiple injuries.
        J Trauma. 1977; 17: 111-121
        • Madsen E.
        Delayed primary suture of flexor tendons cut in the digital sheath.
        J Bone Joint Surg. 1970; 52B: 264-267
        • Green W.L.
        • Niebauer J.J.
        Results of primary and secondary flexor tendon repair in no man's land.
        J Bone Joint Surg. 1974; 56A: 1216-1222
        • Peacock J.B.
        • Proctor H.J.
        Factors limiting extremity function following vascular injury.
        J Trauma. 1977; 17: 532-535
        • Brushart T.M.
        Nerve repair and grafting.
        in: Green D.P. Green's operative hand surgery. 4th ed. Churchill Livingstone, New York1999: 1381-1403
        • Millesi H.
        • Meissl G.
        • Berger A.
        The interfascicular nerve-grafting of the median and ulnar nerves.
        J Bone Joint Surg. 1972; 54A: 727-750
        • Millesi H.
        • Meissl G.
        • Berger A.
        Further experience with interfascicular grafting of the median, ulnar, and radial nerves.
        J Bone Joint Surg. 1976; 58A: 209-218
        • Grabb W.C.
        Median and ulnar nerve suture. An experimental study comparing primary and secondary repair in monkeys.
        J Bone Joint Surg. 1968; 50A: 964-972
        • Bolesta M.J.
        • Garrett W.E.
        • Ribbeck B.M.
        • et al.
        Immediate and delayed neurorrhaphy in a rabbit model: a functional, histologic, and biochemical comparison.
        J Hand Surg. 1988; 13A: 352-357
        • Medinaceli L.D.
        • Seaber A.V.
        Experimental nerve reconnection: importance of initial repair.
        Microsurgery. 1989; 10: 56-70
        • Birch R.
        • Raji A.R.
        Repair of median and ulnar nerves. Primary suture is best.
        J Bone Joint Surg. 1991; 73B: 154-157
        • Medinaceli L.D.
        • Prayon M.
        • Merle M.
        Percentage of nerve injuries in which primary repair can be achieved by end-to-end approximation: review of 2181 nerve lesions.
        Microsurgery. 1993; 14: 244-246
        • Gelberman R.H.
        • Blasingame J.P.
        • Fronek A.
        • et al.
        Forearm arterial injuries.
        J Hand Surg. 1979; 4A: 401-408
        • Hardin W.D.
        • O'Connell R.C.
        • Adinolfi M.F.
        • et al.
        Traumatic arterial injuries of the upper extremity: determinants of disability.
        Am J Surg. 1985; 150: 266-270
        • Wolf Y.G.
        • Reyna T.
        • Schropp K.P.
        • et al.
        Arterial trauma of the upper extremity in children.
        J Trauma. 1990; 30: 903-905
        • Whitehouse W.M.
        • Coran A.G.
        • Stanley J.C.
        • et al.
        Pediatric vascular trauma.
        Arch Surg. 1976; 111: 1269-1275
        • Chen S.H.
        • Wei F.C.
        • Chen H.C.
        • et al.
        Emergency free-flap transfer for reconstruction of acute complex extremity wounds.
        Plast Reconstr Surg. 1992; 89: 882-888