Abstract
Background Traumatic amputation of one or more digits can have a serious detrimental effect
on social and economic standings which can be mitigated by successful replantation.
Little has been recorded on preoperative management before replantation and how this
affects the outcomes of the replanted digit.
Methods A retrospective cohort study was conducted and data collected over an 18-month period.
Three protocols for preoperative management were examined: minimal (basic wound management),
complete Buncke (anticoagulation, dry dressing on amputate placed on indirect ice
and absence of a digital block), and incomplete (any two or three criteria from complete
Buncke in addition to the minimal) protocols. Data was collected on survival rate,
secondary operations, and complication rate. Function was defined by sensation, range
of movement, and strength.
Results Seventy four of 177 digits were replanted with an overall survival rate of 86.5%.
The rates for minimal, incomplete, and complete protocols were 95%, 87%, and 91%,
respectively, and not significantly different. The complication rate was significantly
different between the complete (20%) and minimal (60%) protocols (p = 0.0484). Differences in sensation and grip strength were statistically significant
between protocols (p = 0.0465 and p = 0.0430, respectively). Anticoagulation, no digital block and dry gauze all showed
reduced complication rates in comparison to their counterparts.
Conclusions The Buncke protocol, which includes anticoagulation, no digital block, and dry gauze,
was found to significantly reduce the complication rate which suggests that it prevents
compromise of tissue integrity. Significant differences were found between protocols
for sensation and grip strength. A higher-powered study is needed to investigate the
effects of preoperative management on complication rates and functional outcomes.
Keywords
digit replantation - preoperative management - hand surgery - Buncke protocol
