Long-term functional, subjective and psychological results after single digit replantation

Abstract

ObjectiveThe aim of this study was to analyse the long-term functional, subjective, and psychological results after single-digit replantation.MethodsThirty cases of digital replantation (14 thumbs, 12 index fingers, 2 middle fingers, 1 ring finger, and 1 little finger) in 30 patients (7 females and 23 males) with a mean age of 44.2 years (20–65 years) were evaluated at the end of a mean follow-up time of 36 months (19–50 months). The active range of motion of joints, grip and pinch strength, cutaneous sensibility, upper-extremity functioning, and subjective satisfaction were determined using the Disability of Arm, Shoulder, and Hand (DASH) questionnaire and the Michigan Hand Outcomes questionnaire (MHQ). Psychological sequelae, including depression, anxiety, and posttraumatic stress disorder (PTSD), were assessed. A correlation analysis among variables was also performed.ResultsThe mean score for the DASH questionnaire was 6.6 (range: 0–39.2). The symptom of cold intolerance occurred in 53% of the patients. Two patients were diagnosed with depression, and only one patient exhibited PTSD. The DASH score had a good statistical correlation with total grip strength, pinch grip strength, and static two-point discrimination (S-2PD) (P < 0.05). Several aspects of the MHQ were also statistically relevant to some or all of the three objective results. Furthermore, the grip strength showed significant correlation with DASH and most aspects of the MHQ in multivariate logistic regression analysis (P < 0.05).ConclusionTotal grip strength is the most important factor positively related to subjective outcomes. The incidence rates of psychological symptoms after digit replantation are very low at long-term follow-up.Level of evidenceLevel IV, therapeutic study.

Outcomes Following Replantation/Revascularization in the Hand

“…2 In the literature, the reported values of TAM depends on the level of injury and the digit injured (Table 5 and table 6). 5,17,18,[23][24][25][26][27][28] The mean TAM appears to decrease as the injuries are more proximal (Figure 4).…”

Etiology and Survival of Secondary Revascularizations after Hand and Digit Replantations

“…Ultimately, several options exist, including anastomotic revision, interposition vein grafting, and nonsurgical modalities (leech therapy, heparin-induced bleeding, systemic anticoagulation, etc.). 15,25,29,30,38 To date, there has not been a thorough investigation on their efficacy in secondary revascularization. In our study, we found that replants complicated by venous compromise had higher survival rates if managed with interposition vein grafts (vs. vein revision and nonsurgical modalities).…”

Reporting Outcomes and Outcome Measures in Digital Replantation: A Systematic Review

“…Grip strength 23,41,44,[59][60][61][62] 4. Pinch strength 23,44,59,60,62 5. Time to return to work 9,21,[26][27][28][29]37,39,[58][59][60] 6.…”

“…Congestion (yes/no) 32,40 16,19,20,24,27,37,61,63 1. S2PD 9,20,23,[26][27][28][29]31,39,41,43,47,53,57,[60][61][62][63] 16,17,23,25,33,[35][36][37][38][39][40][41]43,45,[58][59][60] N N 2. Monetary currency 37,38,46 N N Table 7 Hand function outcome measures…”

“…Self-reported ROM 25 N N 5. ROM 9,21,28,29,59,60,62 Abbreviations: MCPJ, metacarpal phalangeal joint; PIPJ, proximal interphalangeal joint; POD, postoperative day; ROM, range of motion; TAM, total active motion. Abbreviation: DASH, Disabilities of the Arm, Shoulder and Hand Questionnaire.…”