Archives of Plastic Surgery

Korean Society of Plastic and Reconstructive Surgeons (대한성형외과학회)
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Short-Term Strength Deficit Following Zone 1 Replantations

  • Roh, Si Young (Department of Plastic and Reconstructive Surgery, Gwangmyeong Sungae Hospital) ;
  • Shim, Woo Cheol (Department of Plastic and Reconstructive Surgery, Gwangmyeong Sungae Hospital) ;
  • Lee, Kyung Jin (Department of Plastic and Reconstructive Surgery, Gwangmyeong Sungae Hospital) ;
  • Lee, Dong Chul (Department of Plastic and Reconstructive Surgery, Gwangmyeong Sungae Hospital) ;
  • Kim, Jin Soo (Department of Plastic and Reconstructive Surgery, Gwangmyeong Sungae Hospital) ;
  • Yang, Jae-Won (Gangnam Jaejun Plastic Clinic for Hand and Plastic Surgery)
  • Received : 2015.03.17
  • Accepted : 2015.06.01
  • Published : 2015.09.15
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Abstract

Background Hand strength deficit following digital replantation is usually attributed to the mechanical deficiency of the replanted digit. Zone 1 replantation, however, should not be associated with any mechanical deficit, as the joint and tendon are intact. We evaluate shortterm motor functions in patients who have undergone single-digit zone 1 replantation. Methods A single-institution retrospective review was performed for all patients who underwent zone 1 replantation. Hand and pinch strengths were evaluated using standard dynamometers. Each set of measurements was pooled according to follow-up periods (within 1 month, 1 to 2 months, 2 to 3 months, and after 3 months). The uninjured hand was used as reference for measurements. Results The review identified 53 patients who had undergone zone 1 replantation and presented for follow-up visits. Compared to the uninjured hand, dynamometer measurements revealed significantly less strength for the hand with replanted digit at one month. The relative mean grip, pulp, and key pinch strength were 31%, 46%, and 48% of the uninjured hand. These three strength measurements gradually increased, with relative strength measurements of 59%, 70%, and 78% for 4-month follow up. Conclusions Despite the lack of joint or tendon injury, strength of the injured hand was significantly lower than that of the uninjured hand during the 4 months following replantation. Improved rehabilitation strategies are needed to diminish the short-term negative impact that an isolated zone 1 replantation has on the overall hand strength.

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References

  1. Hume MC, Gellman H, McKellop H, et al. Functional range of motion of the joints of the hand. J Hand Surg Am 1990; 15:240-3. https://doi.org/10.1016/0363-5023(90)90102-W
  2. Ross DC, Manktelow RT, Wells MT, et al. Tendon function after replantation: prognostic factors and strategies to enhance total active motion. Ann Plast Surg 2003;51:141-6. https://doi.org/10.1097/01.SAP.0000058499.74279.D8
  3. Gunther CM, Burger A, Rickert M, et al. Grip strength in healthy caucasian adults: reference values. J Hand Surg Am 2008;33:558-65. https://doi.org/10.1016/j.jhsa.2008.01.008
  4. Shim JH, Roh SY, Kim JS, et al. Normative measurements of grip and pinch strengths of 21st century Korean population. Arch Plast Surg 2013;40:52-6. https://doi.org/10.5999/aps.2013.40.1.52
  5. Walaszek I, Zyluk A. Long term follow-up after finger replantation. J Hand Surg Eur Vol 2008;33:59-64.
  6. Hasuo T, Nishi G, Tsuchiya D, et al. Fingertip replantations: importance of venous anastomosis and the clinical results. Hand Surg 2009;14:1-6. https://doi.org/10.1142/S0218810409004177
  7. Tamai S. Twenty years' experience of limb replantation: review of 293 upper extremity replants. J Hand Surg Am 1982; 7:549-56. https://doi.org/10.1016/S0363-5023(82)80100-7
  8. Mathiowetz V, Kashman N, Volland G, et al. Grip and pinch strength: normative data for adults. Arch Phys Med Rehabil 1985;66:69-74.
  9. Haidar SG, Kumar D, Bassi RS, et al. Average versus maximum grip strength: which is more consistent? J Hand Surg Br 2004;29:82-4. https://doi.org/10.1016/j.jhsb.2003.09.012
  10. Crosby CA, Wehbe MA, Mawr B. Hand strength: normative values. J Hand Surg Am 1994;19:665-70. https://doi.org/10.1016/0363-5023(94)90280-1
  11. Waikakul S, Sakkarnkosol S, Vanadurongwan V, et al. Results of 1018 digital replantations in 552 patients. Injury 2000;31: 33-40. https://doi.org/10.1016/S0020-1383(99)00196-5
  12. Hattori Y, Doi K, Ikeda K, et al. Significance of venous anastomosis in fingertip replantation. Plast Reconstr Surg 2003; 111:1151-8. https://doi.org/10.1097/01.PRS.0000046497.88549.E0
  13. Chen HC, Tang YB. Replantation of the thumb, especially avulsion. Hand Clin 2001;17:433-45.
  14. Holmberg J, Lindgren B, Jutemark R. Replantation-revascularization and primary amputation in major hand injuries: resources spent on treatment and the indirect costs of sick leave in Sweden. J Hand Surg Br 1996;21:576-80. https://doi.org/10.1016/S0266-7681(96)80134-3
  15. Ohtsuki T. Inhibition of individual fingers during grip strength exertion. Ergonomics 1981;24:21-36. https://doi.org/10.1080/00140138108924827
  16. MacDermid JC, Lee A, Richards RS, et al. Individual finger strength: are the ulnar digits "powerful"? J Hand Ther 2004; 17:364-7. https://doi.org/10.1197/j.jht.2004.04.006
  17. Norman K, Stobaus N, Gonzalez MC, et al. Hand grip strength: outcome predictor and marker of nutritional status. Clin Nutr 2011;30:135-42. https://doi.org/10.1016/j.clnu.2010.09.010

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