Digit Replantation of Eight Years’ Experience: Demographic Characteristics and Outcomes

Introduction: Although amputation of fingers is not a life-threatening event, it does cause functional and psychological problems which can lead to a decrease in quality-of-life. Despite microsurgical and technical advances, it is still difficult to achieve satisfactory functional results in cases of replantations. We report our experience of 8 years of replantation surgery with a discussion of factors than can be important in success.

Methodology and Material: We performed a review of retrospective case series of 60 patients with 85 digit replantations at the same center from 2006 through 2013. Revascularizations or proximal to wrist replantations were excluded. Demographic characteristics, injury type, venue of injury, level of amputation and success rate were examined. Indication for surgery was primarily strong patient desire regardless of the mechanism and level of amputation. The rate of viable digit replantations was determined and successful replantation was confirmed with clinical observation.

Results: During the study period, 85 digit replantations were performed in 60 patients including 53 males and 7 females, with an average age of 31 years old ranging from 1 to 72 years old.

Index finger (27%) was the most commonly replanted digit, followed by the third finger (21%). The left hand (62%) was most often affected. 71% of amputations were realized as occupational accidents. The mechanism of injury was classified as crush in 55%, guillotine in 23% and avulsion in 22% of digits. Level of injury was distal to FDS insertion in 47% and in proximal phalanx in 46% of patients. Mean length of hospitalization was 13 days (range from 2 to 32 days). In total, 42 (49,4%) of the digit replantation procedures were successful. Success rates when grouped according to the type of injury were 80%, 53% and 36% in guillotine, crush and avulsion injuries, respectively. 77% of occupational accidents realized as crush and avulsion injuries.

Conclusions: The rate of success of digital replantation was 49,4% which was lower than several published rates. However, if only guillotine type injuries will evaluated specifically, the success rate can be seen as 80%, similar to the literature. Type and venue of injury were associated with replantation success. This moderate success rate shows us the need of absolute clinical criteria for replantation surgery in case of strong patient desire. Additionally, amputations occurred due to occupational accidents can be evaluated strictly for digital replantation surgery and these data will help to better to inform patients and families about the success rate for that specific population.