Summary
The aim of this study was to evaluate subjective, functional and occupational outcome
after transmetacarpal amputations.
Patients and methods
Forty-three patients (mean age 34, range 1–71) with a transmetacarpal injury devitalizing
three or more finger rays were treated with revascularization (22 patients) or replantation
(21 patients). Most of the injuries (60%) were caused by a circular saw. Altogether
174 rays were injured of which 14 were doomed unsalvageable. An attempt was made to
save the rest (n=160). Metacarpals were shortened on average 8 (range 0–22) mm. The number of arteries repaired varied from 2 to 5 and a vein graft was used in
16 patients. Thirty-eight patients (88%) attended a clinical follow-up examination
performed by an independent observer at mean 9 years (range 2–24 years) after the
injury. Subjective result was documented. Sensation was tested by two-point discrimination
and Semmes-Weinsten filaments. Total active motion of MP- and IP-joints was measured.
Grip and pinch strength was recorded. Functional results were assessed by Tamai's
and Chens scoring systems. Cold intolerance and occupational history was registered.
Results
Primary survival of the replanted or revascularized digital rays was 86% (137/160).
Subjective result was excellent in 11, good in 11, fair in 10 and poor in 6 patients.
Out of 110 revascularized/replanted digits 86 (78%) achieved 2PD, among those the
mean 2PD was 14.7 mm (range 6–25 mm). Total active motion (TAM) was on average 154° (range 20–270°) per injured digit.
The mean grip strength measured 56% (range 3–100%, n=33) and pinch strength 58% (10–100%, n=30) of the uninjured side. Using Tamai's scoring system the outcome was excellent
in eight, good in 11, fair in 12 and poor in seven patients. According to Chen's criteria
the result was excellent in seven, good in eight, fair in 18 and poor in five patients,
respectively. The majority experienced cold intolerance. Sixteen of the 30 manual
workers resumed to their previous or related occupation, ten were re-educated and
four retired.
Conclusions
The majority of transmetal carpal injuries with devascularized rays can be revascularized/replanted
with a good subjective and satisfactory functional end result. Most patients can resume
their old occupations or be employed after re-education.
Keywords
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Article info
Publication history
Published online: April 28, 2007
Accepted:
February 28,
2007
Received:
October 31,
2006
Identification
Copyright
© 2007 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Inc. All rights reserved.
