Index finger salvage with replantation and revascularization: revisiting conventional wisdom.
Replantation/revascularization of severely injured single digits is controversial, especially at the index position. Conventional wisdom is that these digits if salvaged will ultimately worsen residual hand function and they should be amputated. Twenty-eight cases of such index salvages were reviewed to test this hypothesis. Five cases involved children and were excluded. Twenty-three replants/revascularizations survived (100%). Total active motion was 170 degrees in zone 1, and 133 degrees for zone 2 injuries. Patient satisfaction was high in all cases. In selected cases, salvage of severely injured and amputated index fingers has the potential for satisfying survival and functional results and dogmatic treatment with completion amputation should be avoided.
Division of Microsurgery, The Buncke Clinic, California Pacific Medical Center, San Francisco, CA94114, USA. rbuntic@microsurgeon.org
Rudolf F
RF
Buntic
Darrell
D
Brooks
Gregory M
GM
Buncke
D000293:Adolescent; D000673:Amputation, Traumatic / Q000175:diagnosis / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D005260:Female; D005383:Finger Injuries / Q000175:diagnosis / Q000601:surgery*; D005385:Fingers / Q000098:blood supply*; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008866:Microsurgery / Q000379:methods; D008875:Middle Aged; D016059:Range of Motion, Articular; D019651:Plastic Surgery Procedures / Q000379:methods; D020127:Recovery of Function / Q000502:physiology*; D012039:Regional Blood Flow / Q000502:physiology; D012092:Replantation / Q000379:methods*; D012189:Retrospective Studies; D018570:Risk Assessment; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000379:methods; D014945:Wound Healing / Q000502:physiology