Assessment of survival rates compared according to the Tamai and Yamano classifcations in fngertip replantations

Abstract

Background:The fingertip is the most frequently injured and amputated segment of the hand. There are controversies about defining clear indications for microsurgical replantation. Many classification systems have been proposed to solve this problem. No previous study has simultaneously correlated different classification systems with replant survival rate. The aim of the study is to compare the outcomes of fingertip replantations according to Tamai and Yamano classifications.Materials and Methods:34 consecutive patients who underwent fingertip replantation between 2007 and 2014 were retrospectively reviewed with respect to the Tamai and Yamano classifications. The medical charts from record room were reviewed. The mean age of the patients was 36.2 years. There were 30 men and 4 women. All the injuries were complete amputations. Of the 34 fingertip amputations, 19 were in Tamai zone 2 and 15 were in Tamai zone 1. When all the amputations were grouped in reference to the Yamano classification, 6 were type 1 guillotine, 8 were type 2 crush and 20 were type 3 crush avulsions.Results:Of the 34 fingertips, 26 (76.4%) survived. Ten (66.6%) of 15 digits replanted in Tamai zone 1 and 16 (84.2%) of 19 digits replanted in Tamai zone 2 survived. There were no replantation failures in Yamano type 1 injuries (100%) and only two failed in Yamano type 2 (75%). Replantation was successful in 14 of 20 Yamano type 3 injuries, but six failed (70%). The percentage of success rates was the least in the hybridized groups of Tamai zone 1-Yamano type 2 and Tamai zone 1-Yamano type 3. Although clinically distinct, the survival rates between the groups were not statistically significantly different.Conclusions:The level and mechanism of injury play a decisive role in the success of fingertip replantation. Success rate increases in proximal fingertip amputations without crush injury.

A New Technique in Tamai Zone 1 Reconstruction: Reverse Dorsal Terminal Vein Flap (Hat Flap)

“…Replantation is a gold standard in Tamai zone 1 amputation but is not widely used due to the long surgical time, higher costs, lower success rate, and requirement of super microsurgical technique. [11][12][13] The use of composite grafts, an alternative solution, is limited due to unforeseen surgical outcomes. One of the oldest flaps used in fingertip defects is the cross-finger flap, which is a reliable option, but it has two disadvantages including the need for two procedures and connecting two fingers together.…”

Our Experiences about Reconstruction of Tip Amputations

“…In Dadaci et al 's [3] study in 2016, they stated that replantation, if doable, is superior to other alternative methods in the reconstruction of fingertip injuries. In the same study, the mechanism of injury was the determinant of a successful replantation procedure and the success rate was higher in non-crush injuries.…”

Finger Replantation Injury: Approach to Diagnosis and Treatment in the Emergency Department

“…He described three types of injury namely Guillotine, crush, and crush avulsion injury. 17 A Guillotine injury is due to objects with narrow sharp edges such as knives. It results in a clean cut amputation with minimal debridement necessary.…”

“…It results in a clean cut amputation with minimal debridement necessary. 1,17 A crush injury is due to objects with broad and blunt edges such as saw or wooden log. 18 It may create a moderate to severe crushed amputation with significant tissue loss from proximal to distal end of the amputation, requiring an extensive debridement.…”