A retrospective study of functional outcomes after successful replantation versus amputation closure for single fingertip amputations.
OBJECTIVE
To compare the functional outcome of successful microsurgical replantation versus amputation closure for single fingertip amputations.


METHODS
Forty-six fingertip amputations in 46 patients (23 were replanted successfully, 23 had amputation closure) were included in this study. Thumb amputations were excluded. Grip strength and active range of motion of the proximal interphalangeal joint were evaluated. The patients were questioned about their symptoms of pain, paresthesia, and cold intolerance. The Disabilities of the Arm, Shoulder, and Hand questionnaire was given and the disability/symptom score was evaluated. Patients' satisfaction with the surgical result was assessed. Time spent in the hospital and time off from work were reviewed.


RESULTS
Active range of motion of the proximal interphalangeal joint was greater in the successful replantation group. Although the existence of paresthesia and cold intolerance were not statistically different between the 2 groups, pain in the affected fingers was more frequent in the amputation closure group. The average Disabilities of the Arm, Shoulder, and Hand score of the successful replantation group was statistically better. All patients in the successful replantation group were highly or fairly satisfied with the surgical results, whereas 14 patients in the amputation closure group were highly or fairly satisfied. The time spent in the hospital and the time off from work for the successful replantation group were longer.


CONCLUSIONS
Successful replantation of single fingertip amputations can result in minimal pain, better functional outcome, better appearance, and higher patient satisfaction. We recommend attempting fingertip replantation not only to obtain the best appearance but also to gain better functional outcome. If the patient requests the simple surgery and earlier return to work amputation closure is an accepted method despite the disadvantage of digital shortening and the risk for a painful stump.


METHODS
Therapeutic, Level III.
Hattori
Yasunori
Y
Department of Orthopedic Surgery, Ogori Daiichi General Hospital and Yamaguchi University School of Medicine, Ogori, Yamaguchi City, Japan. yhattori@saikyo.or.jp
Doi
Kazuteru
K
Ikeda
Keisuke
K
Estrella
Emmanuel P
EP
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000673:Amputation, Traumatic / Q000601:surgery*; D005260:Female; D005383:Finger Injuries / Q000601:surgery*; D018737:Hand Strength; D006801:Humans; D008297:Male; D008866:Microsurgery; D008875:Middle Aged; D016059:Range of Motion, Articular; D020127:Recovery of Function; D012092:Replantation; D012189:Retrospective Studies