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.