Six Years’ Experience in Crush and Avulsion Type Finger Amputation with Application of Vein Graft

Introduction: Crush and avulsion injuries has still unacceptable and unsatisfactory results in cases of replantations despite microsurgical and technical advances. Additionally, the current indications and contraindications are still controversial. Although replantation of crush and avulsed amputation of fingers is not well indicated, the strong desire of the patient can be an indication for surgery. We report our experience of 6 years using interpositional vein graft when needed in replantation surgery of crushed and avulsed amputations. Our aim is to discuss the correlation between interpositional vein graft and success rate in case of crushed and avulsed finger replantations which was less discussed in the literature.

Methodology and Material: We performed a retrospective review of 38 patients with 50 finger replantations between 2008 and 2013 due to crush and avulsion injuries. Revascularizations or proximal to wrist replantations were excluded. Demographic characteristics, level of amputation, application of interpositional vein graft and success rate were examined. Successful replantation was confirmed with clinical observation.

Results: In our study, of 38 patients, only 3 patients were female. The average age at the time of surgery was 30 years (range in 3-72 years). Of 50 fingers replanted, index (24%) and middle (24%) fingers were most commonly affected. 72% of amputations had work-related injuries in our study. Level of injury was distal to FDS insertion in 48% and in proximal phalanx in 40% of patients. Mean length of hospitalization was 15 days (range from 2 to 32 days). In total, 24 of the digit replantations were successful for a general survival rate of 48%. Rate of application of an interpositional vein graft when required in this type of injury was 54%.

Conclusions: Most authors advocate that the classical indications for replantations. However, strong desire of the patient for replantation may be an indication for surgery. The rate of success of digital replantation due to crush injury was 48% in our study which is similar to the literature. In our study, 72% of amputations was occurred as work related crush and avulsion injuries which can be a contraindication for surgery regarding classical literature. Application of interpositional vein graft when needed is a very good method to increase the replantation success. This modest success rate shows us the standard criteria for digital replantation should not be followed rigidly but instead should be regarded as a general guide in particular in case of strong patient desire.