Retrospective Review of Air Transportation Use for Upper Extremity Amputations at a Level-1 Trauma Center

Abstract

Introduction Air transportation to tertiary care centers of patients with upper extremity amputations has been utilized in hopes of reducing the time to potential replantation; however, this mode of transportation is expensive and not all patients will undergo replantation. The purpose of this study is to review the appropriateness and cost of air transportation in upper extremity amputations.

Materials and Methods Consecutive patients transported by aircraft with upper extremity amputations in a 7-year period at a level-1 trauma center were retrospectively reviewed. The distance traveled was recorded, along with the times of the injury, referral, transportation duration, arrival, and start of the operation. The results of the transfer were defined as replantation or revision amputation.

Results Overall, 47 patients were identified with 43 patients going to the operating room, but only 14 patients (30%) undergoing replantation. Patients arrived at the tertiary hand surgery center with a mean time of 182.3 minutes following the injury, which includes 105.2 minutes of transportation time. The average distance traveled was 105.4 miles (range, 22–353 miles). The time before surgery of those who underwent replantation was 154.6 minutes. The average cost of transportation was $20,482.

Discussion Air transportation for isolated upper extremity amputations is costly and is not usually the determining factor for replantation. The type of injury and patients' expectations often dictate the outcome, and these may be better determined at the time of referral with use of telecommunication photos, discussion with a hand surgeon, and patient counseling.

Level of Evidence III.

Keywords

air transport - upper extremity amputation - digit amputation - replantation

Note

This study did not receive any funding. For this type of study a formal consent is not required.

• References

• 1 Friedrich JB, Poppler LH, Mack CD, Rivara FP, Levin LS, Klein MB. Epidemiology of upper extremity replantation surgery in the United States. J Hand Surg Am 2011; 36 (11) 1835-1840
• 2 Galvagno Jr SM, Haut ER, Zafar SN , et al. Association between helicopter vs ground emergency medical services and survival for adults with major trauma. JAMA 2012; 307 (15) 1602-1610
• 3 Olson MD, Rabinstein AA. Does helicopter emergency medical service transfer offer benefit to patients with stroke?. Stroke 2012; 43 (3) 878-880
• 4 Ozer K, Kramer W, Gillani S, Williams A, Smith W. Replantation versus revision of amputated fingers in patients air-transported to a level 1 trauma center. J Hand Surg Am 2010; 35 (6) 936-940
• 5 Payatakes AH, Zagoreos NP, Fedorcik GG, Ruch DS, Levin LS. Current practice of microsurgery by members of the American Society for Surgery of the Hand. J Hand Surg Am 2007; 32 (4) 541-547
• 6 Mueller MA, Zaydfudim V, Sexton KW, Shack RB, Thayer WP. Lack of emergency hand surgery: discrepancy between elective and emergency hand care. Ann Plast Surg 2012; 68 (5) 513-517
• 7 Lin CH, Aydyn N, Lin YT, Hsu CT, Lin CH, Yeh JT. Hand and finger replantation after protracted ischemia (more than 24 hours). Ann Plast Surg 2010; 64 (3) 286-290
• 8 Scher DL, Boyer MI, Hammert WC, Wolf JM. Evaluation of knowledge of common hand surgery problems in internal medicine and emergency medicine residents. Orthopedics 2011; 34 (7) e279-e281
• 9 Lifchez SD. Hand education for emergency medicine residents: results of a pilot program. J Hand Surg Am 2012; 37 (6) 1245-8.e12
• 10 Hsieh C-H, Tsai H-H, Yin J-W, Chen C-Y, Yang JC-S, Jeng S-F. Teleconsultation with the mobile camera-phone in digital soft-tissue injury: a feasibility study. Plast Reconstr Surg 2004; 114 (7) 1776-1782