Indications and Selection for Digital Amputation and Replantation

Abstract

Even though replantation surgery has now become a routine procedure, it remains delicate and demanding surgery, requiring adequate training and expertise in microsurgical techniques. Well-defined selection criteria for replantation procedures have evolved over the past few years, including definitive guidelines for thumb, single digit, multiple digit and mid-palm amputations. For more complex cases, other techniques, including transpositional microsurgery and various secondary reconstructive procedures, such as toe-to-hand transfer, are now available. Although replantation procedures have been simplified, a second surgical team can save valuable surgical time by debriding and identifying the vessels in the amputated part, harvesting microvenous grafts, and performing bone fixation or tendon repair among other things, while the chief surgeon focuses on revascularization. Overall, the most significant guideline underlining the philosophy of digital replantation today reflects the aim of not only ensuring the survival of a digit, but its functional use as well. Experience dictates that this can be achieved only if the basic principles and indications of replantation surgery are adhered to.

Impact of the number of veins repaired in short-term digital replantation survival rate

“…1 Textbooks and review papers generally support that the indications for replantation should include all thumbs, single digits distal to the insertion of the flexor digitorum superficialis (FDS), multiple digits, and all amputations in children. 3 Certain patient-and finger-specific contraindications may apply, but the surgeon's clinical judgment and the patient's informed consent provide the final decision on whether to operate or to perform a revision.…”

Epidemiology of digital amputation and replantation in Taiwan: A population-based study

“…with advances in microsurgical techniques, replantation is now more widely performed. 3 The publications on digital amputation and replantation have been derived from case series in high-volume hand surgery practices. 4,5 Although these series have provided important demographic and clinical data, the information from these highly selected samples may not reflect the national experience.…”

Case Reports: Thumb Reconstruction Using Amputated Fingers

“…The thumb provides 40% to 50% of total hand function [8]. Thumb transposition using amputated finger remnants is a salvaging procedure in which the greatest functional digit is reconstructed using discarded remnants of other fingers [6].…”