Clinical Factors Associated with Replantation after Traumatic Major Upper Extremity Amputation

Background: Little knowledge exists concerning replantation following traumatic major upper extremity amputation. This study characterizes the injury patterns and outcomes of patients suffering major upper extremity amputation and ascertains clinical factors associated with the decision to attempt replantation. Methods: A retrospective cohort study was conducted on patients treated at a Level I trauma center between June of 2000 and August of 2011. Patients who experienced traumatic upper extremity amputation at or proximal to the radiocarpal joint were included in the study. The subset of patients subsequently undergoing replantation was identified. Medical records were reviewed and bivariate analysis was performed to identify factors associated with attempted replantation and replant survival. Results: Sixty-two patients were treated for traumatic upper extremity amputation and 20 patients underwent replantation. Injury factors associated with attempted replantation included a sharp/penetrating injury (p = 0.004), distal level of amputation (p = 0.017), Injury Severity Score less than 16 (p = 0.020), absence of avulsion (p = 0.002), absence of significant contamination (p 0.001), and lack of multilevel involvement (p = 0.007). Replantation exhibited a complete replant survival rate of 70 percent. An Injury Severity Score of 16 or more was associated with replant failure (p = 0.004). Patients who underwent replantation demonstrated increased rates of secondary surgical revisions (p 0.001) and complications (p = 0.023) and had a greater length of hospital stay (p = 0.024). Conclusions: Several injury characteristics are associated with the decision to attempt replantation of the major upper extremity. A high global injury severity (Injury Severity Score 16) is associated with replantation failure when attempted. Patients who undergo replantation demonstrate higher resource use, warranting further cost-analysis and outcomes investigation. CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, III.