Disability and health after replantation or revascularisation in the upper extremity in a population in southern Sweden – a retrospective long time follow up

BMC Musculoskeletal Disorders

Hans-Eric Rosberg¹ 

[1] Department of Clinical Sciences Malmö – Hand Surgery, Skåne University Hospital, Lund University, 205 02 Malmö, Sweden

关键词: Sense of coherence;    Health outcome;    Disability;    Cold intolerance;    Hand trauma;    Replantation;   

Others  :  1128684
DOI  :  10.1186/1471-2474-15-73

 received in 2013-09-17, accepted in 2014-02-28,  发布年份 2014

【 摘 要 】

Background

Replantation in the upper extremity is a well-established microsurgical procedure. Many have reported patients’ satisfaction and functional measurements.

The aim was to investigate the long time consequences as activity limitations in hand/arm, the general health and cold sensitivity after a replantation or revascularization in the upper extremity and to examine if sense of coherence (SOC) can be an indicator for rehabilitation focus.

Methods

Between 1994–2008, 326 patients needed replantation/revascularization in the upper extremity. 297 patients were followed up. Information was collected from the medical notes and by questionnaires [Quick-DASH (disability hand/arm), EuroQ-5D (general health), CISS (cold sensitivity) and SOC (sense of coherence)]. Severity of injury was classified with the modified Hand Injury Severity Score (MHISS).

Results

The patients [272 (84%) men and 54 (16%) women; median age 39 years (1–81 years)], where most injuries affected fingers (63%) and thumb (25%), commonly affecting the proximal phalanx (43%). The injuries were commonly related to saws (22%), machines (20%) and wood splints (20%). A direct anastomosis (30%) or vein grafts (70%) were used. The overall survival was 90%. 59% were classified as Major.

Equal parts of the injuries took part during work and leisure, DASH scores at follow up were worse (p = 0.005) in the former. Twenty percent changed work and 10% retired early. Patients with early retirement were significantly older, had a more severe injury, worse disability, quality of life and functional outcome. Median DASH score was low [11.4 (0–88.6)] and correlated with severity of injury. Abnormal cold sensitivity (CISS > 50) was seen in 51/209 (24%) and they had a worse disability, quality of life, functional outcome and lower SOC. Patients with a low SOC had on the whole a worse outcome compared to patients with a high SOC and with significant differences in age, EQ-5D, Quick-DASH and CISS.

Conclusions

A high MHISS, abnormal cold intolerance and a low SOC seems to be factors influencing the patients’ outcome and might be relevant in the rehabilitation of the patients. Also, those who had to retire early had a worse disability, quality of life and functional outcome.

【 授权许可】

   
2014 Rosberg; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

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