Background The aim of this study is to conduct a systematic review of the English literature on replantation of distal digital amputations to provide the best evidence of survival rates and functional outcomes. Methods A MEDLINE search using “digit, finger, thumb, and replantation” as keywords and limited to humans and the English language identified 1297 studies. Studies were included in the review if they: (1) present primary data; (2) report 5 or more single or multiple distal replantations; (3) present survival rates. Additional data extracted from the studies meeting the inclusion criteria included demographic information, nature and level of amputation, venous outflow technique, nerve repair, recovery of sensibility, range of motion, return to work, and complications. Results 30 studies representing 2,273 distal replantations met the inclusion criteria. The mean survival rate was 86%. There was no difference in survival between zone I and zone II replantations (Tamai classification). There was a significant difference in survival between replantation of clean-cut versus the more crushed amputations (crush-cut and crush-avulsion). The repair of a vein improved survival in both zone I and zone II replantation. The mean 2-PD was 7mm (n=220) and 98% returned to work (n=98). Complications included pulp atrophy in 14% of patients (n=639) and nail deformity in 23% (n=653). Conclusion The common perception that distal replantation is associated with little functional gain is not based on scientific evidence. This systematic review showed a high success rate and good functional outcomes following distal digital replantation.

Therapeutic, IV.