The long-term functional outcome of the mangled upper extremity intricate management. A single center experience.

Abstract

Purpose: Severe injury of multiple anatomical structures of the upper extremity can be caused by an extremely violent mechanism during labor and motor vehicle accidents, gunshots and explosions. The mangled upper extremity consists of trauma of at least 3 of 4 tissue types: connective tissue (skin, subcutaneous tissue, tendons, muscles), vessels, nerves, and bones. The purpose of this study is to evaluate the medium and long-term results of the limb salvage management of those injuries in our department.

Methods: Sixty-seven patients with multi-injured upper limb were operated in our department between 2014 and 2022 and evaluated with clinical examination and questionnaires (PROMs) on an outpatient basis at a mean follow up of 7.4 years. Patients' demographics, the injured anatomic structures and the surgical interventions needed, were recorded.

Results: The overall outcome, configured by functional scores was quite acceptable concerning injuries' severity. Nineteen patients (29 %) underwent more than one operation, 2-point discrimination test was impaired in 30 % of the patients who had an injured nerve and total loss of regional sensation was diagnosed in 2 patients. Primary amputation was necessary in 8 % of the patients.

Conclusions: Even though the mangled upper extremity refers to a severe injury with often poor postoperative results and high rates of amputations, a thorough evaluation and management by expert hand surgeons is essential for maximizing the possible outcomes.