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. 2022 Jul 27;23(1):35.
doi: 10.1186/s10195-022-00654-7.

Functional outcome after digit replantation versus amputation

Sarah M Bott  1 , Katarzyna Rachunek  1 , Fabian Medved  1 , Thomas S Bott  2 , Adrien Daigeler  1 , Theodora Wahler  3   4
Affiliations

Functional outcome after digit replantation versus amputation

Sarah M Bott et al. J Orthop Traumatol. .

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.

Keywords: Amputation; Digit; Functional outcome; Replantation; Sensitive recovery.

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Conflict of interest statement

The local ethical committee of the University of Tuebingen, Germany approved the study (project number 006/2013B02). No individual person’s data are presented in the manuscript. The datasets used and analyzed during the current study are available from the corresponding author on reasonable request. The authors declare that they have no competing interests. There was no financial support for this work.

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Flowchart depicting the distributions of patients and digits according to the different assessments during follow-up examination. Tests concerning the function of the whole hand and not of a single digit, such as grip strength, pain levels, and DASH score, were performed in patients with a single-digit injury only
Fig. 2
Fig. 2
Photographs showing the examination of the fingertip-to-palm distance (FPD, A) and the fingertip-to-table distance (FTD, B)
Fig. 3
Fig. 3
Pie charts depicting the finger distributions, including the Tamai level of injury, in group R (A) and group A (B). D1 thumb, D2 index, D3 middle, D4 ring, D5 small finger
Fig. 4
Fig. 4
Boxplots comparing the static two-point discrimination in groups R and A. Whiskers extend to a maximum distance of 1.5 interquartile ranges. Outliers are beyond these bars
Fig. 5
Fig. 5
Boxplots comparing the Semmes–Weinstein monofilament level difference between the injured and uninjured sides in groups R and A
Fig. 6
Fig. 6
Boxplots depicting the pain intensity according to the numerical rating scale at rest (A), under strain (B), and in cold temperatures (C) in groups R and A
Fig. 7
Fig. 7
Boxplots presenting the DASH scores in groups R and A
See this image and copyright information in PMC

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