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There is controversy concerning the indications for replantation of a single amputated
digit. Although high success rates have been reported, these reports focused on survival
rates versus functional results.
Purpose: To compare the functional outcome of successful microsurgical replantation versus
amputation closure for single fingertip amputations.
Method: A retrospective analysis on 46 patients with single finger amputations was performed
(23 successful replant, 23 amputation closure). Thumb amputations were excluded. Minimal
postoperative follow-up period was 24 months after successful replantation and 12
months after amputation revision. Post-treatment evaluation included: the Disability
of Arm, Shoulder, and Hand questionnaire (DASH), patient satisfaction, grip strength,
AROM of the proximal interphalangeal (PIP) joint, pain, paresthesia, and cold intolerance.
Hospitalization time and time out off work were also reviewed. Statistical testing
was performed with the Mann-Whitney U test or the chi-square test for comparison of
two-scaled variables.
Results: AROM of the PIP was greater in the replantation group. The existence of paresthesia
and cold intolerance was not statistically different between the two groups; pain
in the affected fingers was more frequent in the amputation closure group. The average
DASH score of the successful replantation group was statistically better. All 23 patients
in the successful replantation group were highly or fairly satisfied with their surgical
results, only 14 patients in the amputation closure group were highly or fairly satisfied.
The successful replantation group experienced longer hospitalization and out of work
time.
Conclusion: Successful replantation of single fingertip amputations can result in minimal pain,
better functional outcome, better appearance, and higher patient satisfaction. The
authors recommend replantation to obtain better appearance and better functional outcome.
Should the patient desire a simple procedure and quicker return to work, amputation
closure is an accepted method despite the disadvantage of digital shortening and the
risk for a painful stump.
Discussion: This study was performed in Japan, where aesthetics are especially important. Confucian
moral values predominate. Maintaining one's bodily integrity and physical appearance
is stressed as much as function. The most important indication for replantation should
be improved hand function when in compliance with the patient's value system. While
replantation may be the ideal method to treat finger amputation, one must consider
the risks and needs. This would include the possibility of replantation failure, the
need for highly skilled microsurgery, longer recovery time, longer time out of work,
and higher cost.
Limitations: This was a retrospective study with a small number of subjects and not a prospective
randomized study. The patients chose their preferred surgical intervention when both
were an option. This created an inevitable bias. The results of pain assessment may
have been influenced by the timing of the assessment. A shorter follow-up period was
used for the amputation closure group because they were discharged earlier. The two
groups would be better compared at the same postoperative time. Another limitation
of this study is that it did not include the postoperative rehabilitation program
after either successful replantation or amputation closure. For example, use of the
affected finger was encouraged; however, specialized desensitization was not applied.
Commentary: There would be value to conducting a randomized, prospective study in multiple cultures
to compare the functional outcome of successful finger replantation versus amputation
closure.
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Article info
Publication history
Hattori Y, et al. J Hand Surg [Am]. 2006;31A:811–8.
Footnotes
Abstracts from the Literature editor is Greg Hritzo, MPT CHT [email protected]
Identification
Copyright
© 2006 Hanley & Belfus. Published by Elsevier Inc. All rights reserved.
