Late results after microvascular reconstruction of severe crush and avulsion injuries of the upper extremity.

From 1978 to 1985, a total of 64 patients underwent successful hand and digit replantation/revascularisation for salvage after crush and avulsion trauma to their upper extremities. Forty-seven of them (39 males and 8 females) were followed between 10 and 17 years (mean: 12.6 years). The average age was 33.2 years. In 39 patients, replantations were performed: 37 digits (including seven thumbs), two hands, and three midhands. Eight patients underwent revascularizations in cases of subtotal amputations: two in the midhand, three at the wrist, and three at the lower arm. Concomitant injury to the hand or forearm was a feature of all cases. In 45 percent of the study population, secondary reconstructions were necessary. Outcomes were evaluated using Chen's classification (1981) and showed that 19 percent of the patients were classified grade 1, 49 percent grade II, 28 percent grade III, and 4 percent grade IV. Results demonstrated a greater patient age in the grade III group, and relatively more secondary operations in the grade IV patients.

[Evaluation criteria in follow-up studies of flexor tendon therapy]. / Bewertungskriterien bei Nachuntersuchungen von Beugesehnenwiederherstellungen

A comparison of results in flexor tendon repair is of value only if standard methods of measurement and recording are used. The function of the involved finger(s) can be judged by measurement of the distance between the finger tip and the distal palmar crease, the total maximum flexion at all three finger joints (composite flexion), the lack of extension as an aggregate of the minimum angles which can be achieved at each of the three finger joints (composite extension deficit), and the total amount of movement (composite flexion minus composite extension deficit). Each of these measurements graded according to a scale of values (table 2 and 3); the sum of these values gives a final classification (excellent, good moderate and poor). In a series of 157 follow-up examinations with 223 fingers with flexor tendon repair this method of recording the results of flexor tendon repair was evaluated.