TY - JOUR
T1 - Traction avulsion amputation of the major upper limb
T2 - A proposed new classification, guidelines for acute management, and strategies for secondary reconstruction
AU - Chuang, D. C.C.
AU - Lai, J. B.
AU - Cheng, S. L.
AU - Jain, V.
AU - Lin, C. H.
AU - Chen, H. C.
PY - 2001
Y1 - 2001
N2 - Major replantation of a traction avulsion amputation is undertaken with the goal of not only the reestablishment of circulation, but also functional outcome. This type of amputation is characterized by different levels of soft-tissue divisions involving crushing, traction, and avulsion injuries to various structures. Between 1985 and 1998, 27 cases were referred for secondary reconstruction following amputation of the upper extremity involving both arm and forearm. Replantation was performed by at least 12 qualified plastic surgeons using different approaches and management, resulting in different outcomes. Initial replantation management significantly affects the later reconstruction. For comparing studies and prognostic implications, the authors propose a new classification according to the level of injury to muscles and innervated nerves: type I, amputation ar or close to the musculotendinous aponeurosis with muscles remaining essentially intact; type II, amputation within the muscle bellies bur with the proximal muscles still innervated; type III, amputation involving the motor nerve or neuromuscular junction, thereby causing total loss of muscle function; and type IV, amputation through the joint; i.e., disarticulation of the elbow or shoulder joint. Some patients required further reconstruction for functional restoration after replantation, but some did not. Through this retrospective study based on the proposed classification system, prospective guidelines for the management of different types of traction avulsion amputation are provided, including the value of replantation, length of bone shortening, primary or delayed muscle or nerve repair, necessity of fasciotomy, timing for using free tissue transfer for wound coverage, and the role of functioning free muscle transplantation for late reconstruction. The final functional outcome can also be anticipated prospectively through this classification system.
AB - Major replantation of a traction avulsion amputation is undertaken with the goal of not only the reestablishment of circulation, but also functional outcome. This type of amputation is characterized by different levels of soft-tissue divisions involving crushing, traction, and avulsion injuries to various structures. Between 1985 and 1998, 27 cases were referred for secondary reconstruction following amputation of the upper extremity involving both arm and forearm. Replantation was performed by at least 12 qualified plastic surgeons using different approaches and management, resulting in different outcomes. Initial replantation management significantly affects the later reconstruction. For comparing studies and prognostic implications, the authors propose a new classification according to the level of injury to muscles and innervated nerves: type I, amputation ar or close to the musculotendinous aponeurosis with muscles remaining essentially intact; type II, amputation within the muscle bellies bur with the proximal muscles still innervated; type III, amputation involving the motor nerve or neuromuscular junction, thereby causing total loss of muscle function; and type IV, amputation through the joint; i.e., disarticulation of the elbow or shoulder joint. Some patients required further reconstruction for functional restoration after replantation, but some did not. Through this retrospective study based on the proposed classification system, prospective guidelines for the management of different types of traction avulsion amputation are provided, including the value of replantation, length of bone shortening, primary or delayed muscle or nerve repair, necessity of fasciotomy, timing for using free tissue transfer for wound coverage, and the role of functioning free muscle transplantation for late reconstruction. The final functional outcome can also be anticipated prospectively through this classification system.
UR - http://www.scopus.com/inward/record.url?scp=0034764111&partnerID=8YFLogxK
U2 - 10.1097/00006534-200111000-00030
DO - 10.1097/00006534-200111000-00030
M3 - 文章
C2 - 11711939
AN - SCOPUS:0034764111
SN - 0032-1052
VL - 108
SP - 1624
EP - 1638
JO - Plastic and Reconstructive Surgery
JF - Plastic and Reconstructive Surgery
IS - 6
ER -