Functional outcome after digit replantation versus amputation

Abstract

Background The success of digit replantation is mainly based on survival rates. The functional outcome as well as the recovery of sensibility are essential parameters for judging the outcome after digit replantation but have been poorly assessed in previous studies. Patients and methods Forty-eight patients with 56 complete traumatic digit amputations occurring between 2008 and 2013 returned for a follow-up examination, the earliest being 6 months postoperatively. Each patient’s range of motion, fingertip-to-table distance, fingertip-to-palm distance, grip and pinch strengths, static two-point discrimination (2-PD), and Semmes–Weinstein monofilament (SWM) test level were assessed in order to compare functional outcome and recovery of sensibility between successful replantation (n = 19) and primary or secondary amputation (n = 37). Subjective assessments of the pain level and function of the upper extremity were performed using the numerical rating scale and the DASH score, respectively. Results Replanted digits achieved 58% of the median total range of motion of the corresponding uninjured digits. Grip and pinch strength were not significantly different after thumb or finger replantation or amputation. Recovery of sensibility was excellent after replantation, with a median static 2-PD of 5 mm and a reduction of pressure sensibility of two levels of the SWM test compared to the contralateral side. After amputation, the median static 2-PD was also very good, with a median value of 6 mm and a reduction of pressure sensibility of only one level according to the SWM test. There was significantly less pain after replantation at rest (p = 0.012) and under strain (p = 0.012) compared to patients after amputation. No significant differences were observed in the DASH score between the two groups. Conclusion Comparable functional results and sensory recovery but significantly less pain at rest and under strain can be expected after digit replantation when compared to digit amputation. Level of evidence IV.

Functional Outcomes in Upper Limb Replantation—A Systematic Review

“…It is true, however, that the scales that appear in most articles are the Disabilities of the Arm, Shoulder and Hand (DASH) (6/11), and the Coping Inventory for Stressful Situations (CISS) (7/11). The DASH assesses subjective distress, activity and participation restriction [ 21 ], as well as ability to perform upper limb activities [ 12 ] (activity limitations and participation restriction) [ 16 ]; the mean score found in the reviewed studies is 28.91 (6.6–75.4). Note that this scale ranges from 0 to 100, where 0 equals no disability and 100 equals severe disability [ 21 ], while the CISS [ 22 ], which assesses cold intolerance, reports 166 people affected.…”

“…Regarding functional outcomes, there are different points of view in the studies reviewed. Some authors state that it is difficult to speak to the benefits seen after reimplantation [36], as well as the important limitations and dysfunctions found after reimplantation [11,37], while others point to satisfactory reimplantation results [12,17,38,39] or the variability of their results [38].…”

“…The factors taken into account when performing replantation, in addition to the characteristics of the lesions themselves, such as their level and mechanism, include ischemia time, age, occupation, the feasibility of replantation (including the surgical technique, material, infrastructure and trained personnel), other concomitant lesions or pathologies [ 11 , 12 ], psychosocial factors, patient involvement and adherence to rehabilitation treatment [ 1 ].…”

Analyzing attempt and success factors for amputated digit replantation in Japan using the diagnosis procedure combination database

“…The reported success rates for the replantation of amputated digits range between 66.3% and 91.4% 2 . The implementation and success rates of digit replantation are very crucial because successful replantation is associated with better pain control and function than those with amputation 3 .…”