Sensory outcome of fingertip replantations without nerve repair

Abstract

The sensory recovery outcomes of fingertip replantations without nerve repair were retrospectively studied. Between 2000 and 2006, 112 fingertip replantations with only arterial repair were carried out in 98 patients. About 76 of the replants survived totally, with a success rate of 67.8%. Evaluation of sensory recovery was possible in 31 patients (38 replantations). Sensory evaluation was made with Semmes-Weinstein, static and dynamic two-point discrimination, and vibration sense tests. Fingertip atrophy, nail deformities, and return to work were also evaluated. According to the Semmes-Weinstein test, 29.0% (11/38) of the fingers had normal sense, 60.5% (23/38) had diminished light touch, 7.9% (3/38) had diminished protective sensation, and 2.6% (1/38) had loss of protective sensation. Mean static and dynamic two-point discriminations were 7.2 mm (3-11 mm), and 4.60 mm (3-6 mm), respectively. Vibratory testing revealed increased vibration in 42.1% of the fingers, decreased vibration in 36.8%, and equal vibration when compared with the non-injured fingers in 21.1%. Atrophy was present in 14 (36.8%) fingers and negatively affected the results. Nail deformities, cold intolerance, return to work, and the effect of sensory education were investigated. Comparison of crush and clean cut injuries did not yield any significant difference in any of the parameters. Patients who received sensory education had significantly better results in sensory testing. The results were classified as excellent, good, and poor based on results of two-point discrimination tests. The outcome was excellent in 18 fingers and good in 20 fingers. Overall, satisfactory sensory recovery was achieved in fingertip replantations without nerve repair.

Fingertip replantation at or beyond the nail base in children

“…Ozcelik et al observed an average of 7.2 mm (3-11 mm) S2PD in 31 surviving replants. 24 Their patients aged from 6 to 40 years consist of patients with amputations distal to the nail root. Dautel noticed a restoration of mean 6.5 mm S2PD in the postoperative finger pulps in eight patients (8 to 15 years old) with replantations beyond the DIP joint.…”

An mHealth App for Users with Dexterity Impairments: Accessibility Study (Preprint)

“…The Purdue Pegboard Assessment, a popularly utilized diagnostic tool for measuring the movements of a person's fingers, hands and arms was used to measure the baseline for participant dexterity levels [18][19][20][21][22]. Four tests from the Purdue Pegboard assessment were used in this study.…”

Replantation Surgery

“…At the fingertip level, satisfactory sensory recovery can be achieved without nerve repair; however, the outcome is lessened and atrophic changes are probable. 35 Hattori et al and Matsuzaki et al 36 reported the outcome of digital replantations when nerve repair was not possible. These studies conclude that the lack of nerve repair in fingertip replantation should not be regarded as a contraindication in the decision-making process.…”

“…As stated previously, satisfactory sensory recovery is possible without nerve repair in fingertip amputations. 35 In major replantations, the priority is to repair the median and radial nerves. If primary nerve repair is not possible after an avulsion injury, the nerve ends can be placed in accessible locations.…”