Sensory recovery following total and subtotal amputations distal to the wrist and digital replantations

Abstract

Apart from the basic aim of revascularization, other criteria for the success of digital replantation are functional and sensory recovery. Tactile gnosis can only be restored in cases of replantation distal to the wrist by paying great attention to the technical details for nerve repair. Of 253 patients who underwent 312 digital replantations, after total or subtotal amputations, over 16 years, 162 with 215 successful replantations and 377 nerve reconstructions returned for follow-up evaluations. Of 320 patients who underwent 395 nerve repairs after isolated severed digital nerves, 198 with 249 nerve reconstructions returned for follow-up. Our aim was to determine in both groups, the level of sensory recovery for primary nerve repair as well as for primary and secondary nerve grafting by evaluating the results according to the score of Highet. The majority of the patients in both groups reached stage S3 to S4 on the sensory recovery score of Highet. Patients with isolated severed nerve reached stage S3+ more often than the patients with nerve reconstruction after replantation. The evaluation of results takes into consideration factors influencing digital sensibility such as the level and type of injury, the length nerve grafts, cold intolerance and the patient's age.