Long-Term Outcomes of Successful Fingertip Replantation: A Follow-Up of at Least 10 Years

Abstract

Background: The purpose of this study was to evaluate the long-term outcome of successful fingertip replantations with more than 10 years of follow-up after surgery. Methods: A total of 34 successfully replanted digits in 31 patients with a mean period to follow-up of 16.5 years were included in this study. The main outcome measures were time to return to work, pain, cold intolerance, sensory recovery, nail deformity, grip strength, range of motion of the thumb interphalangeal or finger distal interphalangeal joint, fingertip atrophy, nonunion, bone shortening, use in activities of daily living, and patient satisfaction. Results: None of the patients reported chronic pain. No cold intolerance was experienced in 32 digits. Semmes-Weinstein monofilament testing showed recovery of protective sensation in 27 digits. The moving two-point discrimination test showed excellent or good recovery in 91 percent of the patients. Sensory recovery was satisfactory, and there was no significant difference regardless of nerve repair or injury type. Moderate to severe nail deformity was found in six digits. Fingertip atrophy was evaluated by comparing the volume of the replanted fingertip with the contralateral digit. The volume was 82 ± 17 percent of the contralateral normal side. There was no significant difference in the volume comparing the level of amputation, injury type, or incidence of postoperative vascular complication. Ninety-seven percent of the patients were satisfied with the results. Conclusion: Long-term outcome of fingertip replantation more than 10 years after surgery was found to be favorable.

Predictors of Success following Microvascular Replantation Surgery of the Upper Extremity in Adult Patients

“…Limited power limited this study, as the replantation surgery is an infrequent occurrence and no prospective national database exists to track occurrence and outcomes. 24,25 A second limitation is with the restraints of the database itself. These include no outcome data other than failure/readmission, no zone of injury documented, mechanism of injury, hospital volume, surgeon volume, and time from injury to surgery, all of which have been demonstrated to be impactful in replantation success.…”

“…These include no outcome data other than failure/readmission, no zone of injury documented, mechanism of injury, hospital volume, surgeon volume, and time from injury to surgery, all of which have been demonstrated to be impactful in replantation success. 2,25 The database does not specifically capture the reason why patients undergo the procedure that they do. This fact prohibits separating patients who undergo amputation as an initial procedure for trauma from those who may have undergone the same procedure for other nontraumatic reasons such as infection.…”

The expression of NOTUM in replantation of severed fingers may be an important treatment factor

“…Multiple digital amputation is a relatively common serious injury among hand trauma (Gürbüz & Yontar, 2021). Replantation of multiple digital amputation is a difficult procedure that takes a long time (Hayashi et al., 2020; Zhou & Zhang, 1991). To preferably restore the shape, sensation and function of the amputated fingers, it is necessary to accurately grasp the surgical indications, master the surgical skill and guide the patient to perform systematic exercises postoperatively (Kaneshiro et al., 2020).…”

The Efficacy of Subdermal Pocket Procedure in Fingertip Replantation With Composite Graft

“…Microsurgical replantation is a standard method with favorable outcomes. [8][9][10] However, especially for amputations near or distal to the nail base, it is rather challenging to identify a distal artery and manage anastomosis of submillimeter vessels and venous congestion. 3,6 On the other hand, composite grafting seems to be a reasonable choice with easy technique and cost-effectiveness for this kind of distal fingertip amputation.…”

“…1,2 Microsurgical replantation is an effective method with good results but it is often technically challenging especially in amputations distal to the nail base. [3][4][5][6][7][8][9][10] Moreover, microsurgical replantation is contraindicated in certain cases including lack of microsurgical capability, severe crushing or avulsive injuries, and lack of suitable vessels. 2,6 For these situations, composite grafting seems to be a reasonable treatment alternative.…”