Microsurgical Digits Replantation in Resource-Limited Setting: A Retrospective Study

Abstract

Background: This article aims to share our experiences with microsurgical finger replantation in a resource-limited setting.

Methods: This multi-institutional, retrospective study included 21 cases of finger amputation that underwent microsurgical replantation, within 7 years period. Patient demographics, preoperative assessments, surgical approaches, and outcomes were documented and analyzed. A univariate analysis was performed to obtain factors associated with digit reimplantation failure.

Results: Out of 21 cases included, 8 (38.1%) had complete amputations and 13 (61.9%) had incomplete amputations. Crush injuries accounted for the majority (71.4%). On average, 2.2 ± 1.1 digits were affected, with the ring finger being the most commonly injured (71.4%). The mean operative time was 121.5 ± 26.8 minutes. The success rate of digit replantation was 76.2%. During a mean follow-up of 14.3 ± 3.7 months, 85.7% of successfully replanted digits considered their replantation results satisfactory. The majority of replanted digits demonstrated active and effective holding and grasping abilities without pain or instability (76.2%). Replantation failure was associated with a higher number of affected digits (p < 0.001), longer operative time (p = 0.004), complete avulsion (p = 0.003), current smoking (p = 0.025), diabetes (p = 0.006), hypertension (p = 0.047), procedure difficulty score (p= 0.004), and occurrence of complications (p < 0.001).

Conclusion: Microsurgical finger replantation can yield favorable outcomes and acceptable survival rates, even within resource-limited settings. However, this procedure requires specialized equipment and personnel that may not be available at all institutions. Influential factors in digit replantation failure, include an increased number of damaged digits, extended operative duration, complete avulsion, current smoking, diabetes, hypertension, procedure difficulty score, and postoperative complications occurrence.

Keywords: amputation; digital replantation; microsurgery; resource-limited setting.

Figure 1

Index and middle fingers amputation and devascularization (A). Bone fixation by K-wires (B). Microvascular anastomosis, two digital arteries, one dorsal vein, and two digital nerves for each finger (C). Post-operative finger appearance (D), on the third postoperative day (E). Showing accepted finger grasp function (F).

Figure 2

Thumb fingertip amputation beyond the Distal interphalangeal joint (A). Amputated tip (B). Reattached the fingertip (C). Postoperative appearance (D). 5th-week postoperative appearance [Palmar view (E) and Dorsal view (F)].

Figure 3

Thumb fingertip amputation beyond the Middle phalanx joint (A). Amputated finger (B). Reattached the finger using one vein repair and one vein graft (C). Postoperative finger appearance (D). 5^th-week postoperative appearance (E).

Figure 4

Severe injured proximal right hand with multiple fingers amputation and devascularization (A and B). Replantation and bone fixation by K-wires (C). Postoperative appearance with good color, warm, normal capillary refilling (D and E). 5th-week postoperative appearance (F).