Amputation transhumérale pour séquelle de plexopathie brachiale. Une série multicentrique

Background: A flail limb can be the result of a traumatic complete brachial plexus lesion. Some patients prefer retaining the flail limb; however, some patients feel that a flail limb negatively affects daily life. In these circumstances, an elective amputation is sometimes elected; however, long-term follow-up, with respect to satisfaction and function, is unknown. The aim of this study is to evaluate the long-term outcome of this rare and life changing operation. Materials and methods: Eight patients with a transhumeral amputation performed in 2 specialized medical centers were included. Postoperatively, the functional and psychological outcome and the quality of life were evaluated with standardized patients reported outcome measures (PROMs; DASH, SIP-68, EQ-5D-5L and HADS). Results: After a median of 9.4 (range 7.5–12.8) years follow-up, 7 patients (88 %) stated that they would undergo the operation again and were satisfied with the results. At latest follow-up, the median DASH score was 37.3 (range 8.3–61.7), the median SIP-68 score was 6.5 (range 0–43) and the median HADS score was 3.0 (range 0–14) for anxiety and 3.0 (range 1–19) for depression. In the EQ-5D-5L, patients had most difficulties in self-care, usual activities and pain/discomfort. The median overall health status was 69 (range 20–95). Discussion: With the right indication, a transhumeral amputation is a reasonable option for traumatic complete brachial plexus lesion with satisfying long-term results. Level of evidence: IV, multicenter case series.