Personalized Treatment Decisions for Traumatic Proximal Finger Amputations: A Retrospective Cohort Study

Abstract

Ray and proximal phalanx amputations present valid surgical options for the management of severe traumatic finger injuries. However, among these procedures, the superior one for optimal functionality and quality of life for patients still remains unknown. This retrospective cohort study compares the postoperative effects of each amputation type to provide objective evidence and to create a paradigm for clinical decision-making. A total of forty patients who had received either ray or proximal phalanx-level amputations reported on their functional outcomes using a combination of questionnaires and clinical testing. We found a decreased overall DASH score following ray amputation. Particularly, Part A and Part C of the DASH questionnaire were consistently lower compared with amputation at the proximal phalanx. Pain measurements in the affected hand were also significantly decreased during work and at rest in ray amputation patients, and they reported decreased cold sensitivity. Range of motion and grip strength were lower in ray amputations, which is an important preoperative consideration. We found no significant differences in reported health condition, evaluated according to the EQ-5D-5L, and blood circulation in the affected hand. We present an algorithm for clinical decision-making based on patients’ preferences to personalize treatment.

Blood Vessel Injuries of the Fingers: A Clinical Comparison of One- and Two-Arterial Blood Supply

“…Traumatic finger injuries can greatly influence hand, wrist, and upper limb function and affect patients’ daily lives [ 13 , 14 ]. It is therefore imperative that surgeons understand the factors involved in wound healing and reconstructive surgery in order to allow them to apprise patients of their decision making and to maximize patients’ functional outcomes following these injuries [ 4 ]. In our retrospective study, we examined the role of arterial blood supply in finger healing by comparing the results of a patient cohort with one-artery blood supply versus a cohort with two-artery blood supply.…”

“…Finger reconstructive surgery aims to restore the digit’s length, sensation, and appearance in order to recapitulate the preinjury function and esthetic to the highest degree possible. The hand’s essential roles in communication, work, and psychological wellbeing underline the important contribution of reconstructive surgery for the patients’ functional outcomes and quality of life [ 4 ].…”