Advances in digital replantation

Abstract

Technical advances in revascularization and in skin cover have resulted in increases in the possibilities of digital replantation. In cases of multiple digital lesions and isolated avulsions of the thumb, all attempts to ensure recovery of basic pinch capacity are justified. On the other hand, in cases of proximal amputations with extensive avulsion or crush injury such attempts should be abandoned if results on function are important. Primary and secondary surgery must confront two difficult problems namely, repair of the avulsed flexor tendons and resensibilization. But in the field of replantation one should not be too dogmatic because for cosmetic reasons, some patients may find even a stiff or insensitive finger satisfactory. Distal and very distal replantations yield the best results in all fields. This information should be brought to the attention of all trauma teams that tend to consider such replantations useless. These replantations are both rapid and simple, requiring only mastery of suturing vessels 0.5 mm in diameter. The surgeon responsible for replantation should weigh the indications after assessing the patient's needs and explaining the advantages and drawbacks of this type of surgery and its results on function.