Finger Replantation, Good and Bad Results

Introduction: There are different causes for finger amputation. Causes are starting from clean cut amputation up to avulsion. There are many factors affecting the results of finger replantation, as cause of injury, age of the patient, level of amputation, time passed after injury, methods for preservation of the amputated part, trained surgeons, and surgical equipments.

Methodology and Material: This study included 38 patients presented by amputation of 57 fingers. The average age was 23 years old. The main cause was machine injury. The dominant hand was the right hand. The dominant finger was the thumb. The level of injury was proximal to the proximal interphalangeal joint in most of cases. The average time passed between injury and replantation was 2 hours. The average time of surgery for one digit replantation was 4 hours. The principles of treatment was exploration of the neurovascular and tendons in the amputated digit first then that of the stump. The order of treatment was bone fixation by 2 kirschner wire and one kirschner sometimes, digital artery, digital vein, flexor tendon, digital nerve, extensor tendon. Skin closure should be loosed.

Results: The average follow up was 58 month. All fingers have been survived except five. The average time for bone union was 8 weeks. According to Chen's criteria, the overall results were classified as grade I (excellent) in 20 cases, grade II (good) in 16 cases and grade III (fair) in 2 cases. The tendon function was excellent in 20 fingers, good in 26 fingers fair in 3 fingers, poor in 2 fingers and failure of 6 fingers. The 2 point discrimination was 6 mm in 9 fingers, 7-10 mm in 29 fingers, and 12-15 mm in 13 fingers. The mean grip and pinch strengths were 80% and 85% respectively compared with contralateral hand.

Conclusions: Finger replantation is not an easy job and it is considered as challenging procedure even for the specialist. I think that many factors affecting the results of finger replantation have not been discovered yet.