Pain after replantation and revascularisation

Abstract

This prospective survey was carried out between 1992 and 1996 to assess the incidence and characteristics of chronic pain after replantation. Digital replantation was successfully carried out in 428 patients, and major limb replantation in a further 82. All were followed up for at least 2 years. Significant chronic pain was found in 9% (39 patients) of those who had digital replantation and in 24% (20 patients) of those who had major limb replantation. Most of the patients showed improvement after conservative treatment and reconstructive surgery. However, a poor functional outcome was usually related to chronic pain. The severity and extent of injury was also related to chronic pain. Adequate post-operative pain control could lessen chronic pain. Injury at the distal parts of the digits was associated with chronic pain in digital replantation. Injury at the proximal part of the upper limb in major limb replantation usually produced brachial plexus injury which resulted in deafferentation pain and a poor functional outcome.