Upper limb replantation: functional disability and quality of life challenges

Abstract

Background: Upper limb replantation, while surgically complex, demands a multidimensional assessment of functional recovery, subjective satisfaction, and quality of life beyond mere anatomical survival of the limb. Objective: This study aimed to evaluate the functional outcomes, health-related quality of life, and perceived satisfaction of patients after upper limb replantation, with special attention to the impact of surgical reintervention, rehabilitation, and return to work. Methods: We conducted a cross-sectional observational study including 62 patients treated at a referral center between 2021 and 2023. Patients were assessed using validated instruments (DASH, SF-12, Russell test) alongside clinical and sociodemographic data. Statistical analyses explored associations between reintervention, functionality, quality of life, and work reintegration. Results: Nearly half of the patients required reintervention, which was significantly associated with greater functional disability in occupational and recreational contexts and lower subjective use of the hand in daily activities. Return to work was linked to better functional scores, although quality of life measures showed limited association with functional outcomes. Conclusion: Surgical reintervention and failure to return to work are key factors associated with perceived disability after upper limb replantation. These findings highlight the need for individualized, multidisciplinary follow-up protocols that integrate functional, psychological, and occupational rehabilitation strategies to optimize patient recovery.