Resection-Replantation vs. Bionic Reconstruction to Restore Hand Function

Aim:

Above-elbow amputation results in profound functional and psychosocial impairments. Modern bionic reconstruction has improved outcomes in these patients, but several limitations remain. In situations where the hand remains unaffected by trauma or tumor, segmental limb resection followed by immediate replantation offers a viable alternative to amputation. However, comparative functional outcome data between these approaches are lacking. To guide clinical decision-making, this study aimed to compare functional outcomes after resection-replantation (RR) and modern bionic reconstruction (BR) at the transhumeral level.

Methods:

In a cross-sectional comparative study, outcomes were assessed in 2 patient groups. RR (n = 3) underwent transhumeral resection and distal limb replantation, whereas BR (n = 3) had transhumeral amputation followed by bionic reconstruction, including targeted muscle reinnervation and osseointegration. Functional outcomes were evaluated using the Southampton Hand Assessment Procedure (SHAP). Additional assessments included subjective impairment of limb function, health-related quality of life, limb-related pain, and embodiment. Sensation, grip strength, and pinch strength were further evaluated in RR patients.

Results:

Median follow-up was 4.5 years in RR (range 3-51) and 2 years in BR (range 2-5). SHAP scores were higher in RR (mean 78, range 74-84) than in BR (mean 30, range 29-31). Amputation-related pain was reported in 2 BR patients, while no RR patients suffered pain as a result of the intervention. Other outcome measures were comparable between groups. All RR patients retained critical sensation in the hand, while grip and pinch strength were similar to those achieved with prosthetic hands.

Conclusions:

RR demonstrated superior functional outcomes compared with BR at the transhumeral level. In addition to enhanced function, this approach was not associated with phantom-limb pain, promoted a high degree of embodiment and avoided prosthetic-related costs. The preservation of sensation and proprioception likely plays a critical role in improved functionality. Where RR is feasible in selected cases of upper extremity trauma or tumor, it should be considered a preferred alternative to above-elbow amputation for restoring hand function.

Evidence Level: