Long-term outcome following upper extremity replantation after major traumatic amputation.

BACKGROUND: Amputations in general and amputations of upper extremities, in particular, have a major impact on patients' lives. There are only a few long-term follow-up reports of patients after macro-replantation. We present our findings in contrast with the existing literature. METHODS: Sixteen patients with traumatic macro-amputation of an upper extremity were eligible for inclusion in this study. Altogether, the patients underwent replantation in 3 institutions between 1983 and 2011. RESULTS: Twelve male and four female patients with an average age at injury of 40.6 years (range, 14-61 years) were included in this study. The mean follow-up period was 13.5 years (range, 4.4-32.6 years; SD, 5.7 years). The mean disabilities of the arm, shoulder and hand (DASH) outcome measure was 41 (range, 5.2-94.8; SD, 18.2), functional independence measurement (FIM) was 125 (range, 120-126; SD, 1.8). Chen I representing very good function was accounted in six, Chen II representing good function in eight, Chen III (fair) in one and Chen IV (bad function) in one patient. CONCLUSIONS: We found that while the majority of the included patients exhibited good or very good function of the extremity, none of the replanted appendages regained normal levels of functionality. In addition, all participants were very satisfied with their outcomes. Positive long-term results with high rates of subjective satisfaction are possible after replantation of upper extremities.

Nitrogen dynamics of a mountain forest on dolomitic limestone--a scenario-based risk assessment.

The dominant nitrogen (N) fluxes were simulated in a mountain forest ecosystem on dolomitic bedrock in the Austrian Alps. Based on an existing small-scale climate model the simulation encompassed the present situation and a 50-yr projection. The investigated scenarios were current climate, current N deposition (SC1) and future climate (+2.5 degrees C and +10% annual precipitation) with three levels of N deposition (SC2, 3, 4). The microbially mediated N transformation, including the emission of nitrogen oxides, was calculated with PnET-N-DNDC. Soil hydrology was calculated with HYDRUS and was used to estimate the leaching of nitrate. The expected change of the forest ecosystem due to changes of the climate and the N availability was simulated with PICUS. The incentive for the project was the fact that forests on dolomitic limestone stock on shallow Rendzic Leptosols that are rich in soil organic matter are considered highly sensitive to the expected environmental changes. The simulation results showed a strong effect due to increased temperatures and to elevated levels of N deposition. The outflux of N, both as nitrate (6-25 kg N ha(-1)yr(-1)) and nitrogen oxides (1-2 kg N ha(-1)yr(-1)), from the forest ecosystem are expected to increase. Temperature exerts a stronger effect on the N(2)O emission than the increased rate of N deposition. The main part of the N emission will occur as N(2) (15 kg N ha(-1)yr(-1)). The total N loss is partially offset by increased rates of N uptake in the biomass due to an increase in forest productivity.