Assessment of Survival Rates in Reference to Tamai and Yamano Classifications in a Series of 23 Consecutive Fingertip Replantations

Introduction: Fingertip is the most frequently injured and amputated segment of the hand. Despite current advances in microsurgery, fingertip replantation is still controversial mainly due to its difficulty and cost.

Tamai classification is a simple and practical as it divides the phalanx into two anatomical zones. Distal zone (zone 1) extends from the fingertip to the base of the nail, whereas the proximal zone (zone 2) extends from the base of the nail to the distal interphalangeal joint. Yamano has classified fingertip amputations with regard to the mechanism and severity of the injury. There are numerous studies in the literature which evaluate fingertip replantation outcomes through the scope of either Tamai or Yamano classifications. However, in our knowledge of the literature, there is no previous study which simultaneously correlates these two classification systems with the replant survival rate.

Methodology and Material: Patient charts of 23 consecutive fingertip replantations that have been performed between 2007 and 2013 were retrospectively reviewed in respect to Tamai and Yamano classifications. All the injuries were complete amputations.

Results: The average age of patients (21 male, 2 female) in our series was 35.6 years. Average ischemia time was 3 hours. Out of 23 fingertip amputations, 13 were in Tamai zone 2 and 10 were in Tamai zone 1. When all amputations were grouped in reference to Yamano classification; 3 were type 1 Guillotine, 4 were type 2 crush and 16 were type 3 crush-avulsions. 18 out of 23 fingertips survived (78.2%). 7 out of 10 (70%) replantations performed in Tamai zone 1 and 11 out of 13 replantations (84.6%) performed at Tamai zone 2 survived. No replants have failed in Yamano Type 1 or Yamano type 2 cases. 11 of 16 Yamano type 3 injuries were successful and 5 failed (68.75%). Although clinically distinct, the survival rates between groups were not statistically different.

Conclusions: Both the level and the mechanism of the injury play a decisive role in the success of surgery in fingertip replantation. Success rate increases in proximal fingertip amputations without crush injury. Although technically demanding, replantation should be considered in suitable patients with distal fingertip amputations.