Fingertip injury
A Retrospective Study of Functional Outcomes After Successful Replantation Versus Amputation Closure for Single Fingertip Amputations

https://doi.org/10.1016/j.jhsa.2006.02.020Get rights and content

Purpose

To compare the functional outcome of successful microsurgical replantation versus amputation closure for single fingertip amputations.

Methods

Forty-six fingertip amputations in 46 patients (23 were replanted successfully, 23 had amputation closure) were included in this study. Thumb amputations were excluded. Grip strength and active range of motion of the proximal interphalangeal joint were evaluated. The patients were questioned about their symptoms of pain, paresthesia, and cold intolerance. The Disabilities of the Arm, Shoulder, and Hand questionnaire was given and the disability/symptom score was evaluated. Patients’ satisfaction with the surgical result was assessed. Time spent in the hospital and time off from work were reviewed.

Results

Active range of motion of the proximal interphalangeal joint was greater in the successful replantation group. Although the existence of paresthesia and cold intolerance were not statistically different between the 2 groups, pain in the affected fingers was more frequent in the amputation closure group. The average Disabilities of the Arm, Shoulder, and Hand score of the successful replantation group was statistically better. All patients in the successful replantation group were highly or fairly satisfied with the surgical results, whereas 14 patients in the amputation closure group were highly or fairly satisfied. The time spent in the hospital and the time off from work for the successful replantation group were longer.

Conclusions

Successful replantation of single fingertip amputations can result in minimal pain, better functional outcome, better appearance, and higher patient satisfaction. We recommend attempting fingertip replantation not only to obtain the best appearance but also to gain better functional outcome. If the patient requests the simple surgery and earlier return to work amputation closure is an accepted method despite the disadvantage of digital shortening and the risk for a painful stump.

Type of study/level of evidence

Therapeutic, Level III.

Section snippets

Inclusion and exclusion criteria

The primary inclusion criterion of this study was a single fingertip amputation treated by either successful microsurgical replantation or amputation closure as a primary procedure. We classified the level of amputation according to Tamai (ie, zone 1 for amputations distal to the nail base and zone 2 for amputations between the distal interphalangeal joint and the nail base).4 Patients with zone 1 amputations were included in this study. The minimum postoperative follow-up period was 24 months

Results

The age at the time of injury and the distribution of the affected fingers did not differ significantly between the 2 groups. The follow-up period for patients in the successful replantation group was statistically longer.

The grip strength did not differ significantly between the 2 groups. Active ROM of flexion of the PIP joint in the successful replantation group was significantly greater. No patients in either group changed their occupation after the injury. Although the existence of

Discussion

The primary goal for treatment of fingertip amputation includes maintenance of digital length, good soft-tissue coverage, painless fingertip with durable and sensate skin, and preservation of the nail. From these points of view successful replantation seems an ideal method for treatment of fingertip amputation. The long-term results of our 23 successful replantations were encouraging. The average active ROM of the distal interphalangeal joint in 18 fingers, when preserved, was −2° ± 6° of

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