title: Do we need to repair the nerves when replanting distal finger amputations?
abstract: Distal replantation is an excellent model to study the results of nerve repair. We aim to demonstrate differences in aesthetic, sensory, and functional outcomes in fingertip replantation, with and without nerve repair. We recruited 28 fingers in 28 patients, who had successful distal replantation in 5 years. Half of the fingers had nerves repaired. Mean follow-up was 39 months. Symptoms of pain, numbness, cold intolerance, scar hypersensitivity, pulp atrophy, and weakness were reported. Nail width, pulp length, 2-point discrimination, Semmes-Weinstein test, and power were evaluated. We used chi-square tests of independence to examine association between nerve repair and symptoms, and independent T tests and Mann-Whitney U tests to analyze difference between replantation with and without nerve repair according to objective results. Chi-square tests reviewed no significant association between nerve repair and symptoms. Mann-Whitney U tests showed no significant difference between the groups, with and without nerve repair. All fingers showed mean 2-point discrimination of 5.6 mm, and Semmes-Weinstein test results of green in 3 fingers and blue in 17. There was no significant difference in overall outcomes in repairing nerve or not in distal finger replantation. Both groups had satisfactory outcomes. Possibly, spontaneous neurotization is present, and nerve repair is not necessary, which may help to shorten the operation time and decrease extensiveness of surgeries.
authors.affiliation: Department of Orthopaedics and Traumatology, Prince of Wales Hospital, Shatin, N.T., Hong Kong. clara.wongclara@gmail.com
authors.forename: Clara
authors.initials: C
authors.lastname: Wong
authors.forename: Pak Cheong
authors.initials: PC
authors.lastname: Ho
authors.forename: Wing Lim
authors.initials: WL
authors.lastname: Tse
authors.forename: Sally
authors.initials: S
authors.lastname: Cheng
authors.forename: Derwin King Chung
authors.initials: DK
authors.lastname: Chan
authors.forename: Leung Kim
authors.initials: LK
authors.lastname: Hung
mesh_terms: D000328:Adult; D000673:Amputation, Traumatic / Q000601:surgery*; D000714:Anastomosis, Surgical; D016009:Chi-Square Distribution; D015331:Cohort Studies; D005260:Female; D005383:Finger Injuries / Q000175:diagnosis / Q000601:surgery; D005385:Fingers / Q000294:innervation* / Q000601:surgery; D018737:Hand Strength / Q000502:physiology; D006801:Humans; D006987:Hypesthesia / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D009262:Nails / Q000254:growth & development; D016067:Nerve Transfer / Q000379:methods*; D011336:Probability; D020127:Recovery of Function; D012092:Replantation / Q000379:methods*; D012189:Retrospective Studies; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D018709:Statistics, Nonparametric; D014110:Touch; D055815:Young Adult