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Upper Extremity Microsurgery on Methamphetamine: A Review of 4402 Trauma Admissions
Gabrielle LaBove, MD1, Shawn Diamond, MD2, Hayk Stepanyan, MD1, Ranjan Gupta, MD3 and Amber Leis, M.D.1, (1)University of California, Irvine, Orange, CA, (2)Texas Tech University Health Sciences Center of El Paso, El Paso, TX, (3)Orthopedic Surgery, University of California, Irvine, Orange, CA

Upper Extremity Microsurgery on Methamphetamine: A Review of 4402 Trauma Admissions

Background;

Methamphetamine intoxication amongst trauma patients in the United States is rising regionally. The effects of stimulant intoxication on acute care microneurosurgical reconstruction is unknown. Our group sought to define rates of upper extremity microsurgical reconstructions in the presence of methamphetamine and associated complications.

Methods:

All trauma admissions in a single Calendar year at a University, Level 1 trauma center were reviewed. Patients undergoing microneurosurgical operations to the upper extremity were selected and compared based on the presence of a positive urine toxicology screen for Methamphetamine.

Results:

During the study period, 4402 trauma patients were evaluated, 545 (12.8%) tested positive for stimulant narcotics of which 108 had upper extremity injuries. Forty-eight patients underwent upper extremity microneurosurgical procedures for trauma while eight (16.7%) tested positive for Methamphetamine. Those who tested positive were more often male (p<0.01), had concomitant Tobacco and Alcohol use (p=0.01), coexisting psychiatric problems (75% vs 11.7%; p=0.004), engaged in high-risk activities such as assaults, stabbings and shootings (62% vs. 22.5%; p=0.04). and higher average injury severity score (23.2 vs 8.8; p<0.01). Injury patterns differed significantly. Spaghetti wrist (75% vs. 7.5%; p<0.01) and major peripheral nerve injuries were more common in methamphetamine users. The majority of Methamphetamine users experienced intraoperative vasospasm requiring intervention (62% vs 16%; p<0.01). Rates of digital ischemia, replantation loss, flap loss, need for revision amputation and or microvascular collapse did not differ between groups. Overall revascularization and replantation success rate in the cohort was 89% with five failures. Sources of revascularization and replantation failure included blunt or blast mechanisms (OR 4.5; p<0.05) and longer operative time (322 vs 222 minutes; p<0.01).

Conclusion:

Stimulant narcotics found on urinary toxicology screen should not preclude consideration of microsurgical reconstruction in the setting of mutilating injuries of the upper extremity. The operating microsurgeon must remain vigilant and ready to manage vasospasm that is present in the majority of methamphetamine users.


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