[Results of 46 digital replantations. With a minimal follow-up of one year].
Forty six digital replantations were analysed with a minimum follow-up of one year. The mechanism of the injury and the level of the amputation were systematically analysed to asses the objective (mobility, sensitivity, prehension), and the subjective results (pain, vasomotor dysfunction, satisfaction). The replantations were typically in the long fingers in young men (index and middle fingers at the level of the middle phalanx) by work or industrial accident (complete section or digital crushing). Seventeen replantations (37%) were secondarily amputated. Arterial thrombosis was the main cause of amputation in 94% of the cases and had occurred in 50% of the cases by the forty eight postoperative hour. An early revascularization procedure was attempted in ten cases (21%). Among these ten revascularizations procedures, we noted eight failures (80%). During the first six postoperative weeks, the complications of the replantations were skeletal displacements, tendon ruptures and joint subluxations. After six weeks, the complications were joint stiffness (26%), sensory deficits (19.5%), severe cold intolerance (13%), vasomotor dysfunction (10%) with stiffness of the proximal interphalangeal joints in 60% of the cases. We noted other complications such as neuroma of distal stump, cutaneous retraction and deformation of the fingers. Finally, only nine digital replantations (19.5%) evolved favourably with complete restoration of sensorimotor function without any complication. The best results were obtained from amputations of the middle finger with the mechanism of section being a circular saw (40%).
Dos Remédios
C
C
Service d'orthopédie B, hôpital Roger-Salengro, CHRU de Lille, 59037 Lille, France. remedios@libertysurf.fr
Leps
P
P
Schoofs
M
M
D000062:Accidents, Occupational; D000293:Adolescent; D000328:Adult; D000673:Amputation, Traumatic / Q000601:surgery*; D005260:Female; D005383:Finger Injuries / Q000209:etiology / Q000601:surgery*; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D012092:Replantation; D013997:Time Factors; D016896:Treatment Outcome