title: Replantation versus revision of amputated fingers in patients air-transported to a level 1 trauma center.
abstract: OBJECTIVE
  To assess the rate of replantation versus revision of amputated fingers in patients air-transported to a tertiary care hand trauma center.
  
  
  METHODS
  We included 40 consecutive subjects (70 digits) who were transported via air after digit(s) amputation distal to the metacarpophalangeal joint. The primary outcome measure was type of surgery (attempted replantation vs revision of the amputation). Data were collected prospectively.
  
  
  RESULTS
  We identified 3 groups of patients. In group 1 (15 patients, 23 digits), replantation of one or more digits was attempted. In group 2 (6 patients, 8 digits), replantation was not elected. In group 3 (19 patients, 39 digits), no digits were suitable for replantation. The mean age was 36.2 years (range, 5-69 years) and mean time of transport was 5.15 hours (range, 1-24 hours). Mechanisms of finger injury were crush (n = 34), followed by clean cut (n = 15), avulsion/crush (n = 15), and gunshot (n = 6). No significant differences were found between groups for age or time elapsed from injury to hospital arrival. Most patients (n = 25; 65%) transported via air did not undergo replantation surgery. Injury characteristics (n = 18 patients, 72%) were the main reason not to replant. The most common reason for the refusal of replantation was inability to return to work immediately. The most common reasons for surgeon's decision to not to replant were single digit amputations proximal to flexor digitorum superficialis attachment (7 patients), and crush/avulsion type injuries (7 patients), followed by health status and age (5 patients).
  
  
  CONCLUSIONS
  This study shows that a considerable portion of patients transported via air do not undergo replantation surgery. Further studies are needed to establish whether this is an overused service.
authors.affiliation: Denver Health Medical Center, Department of Orthopedics, University of Colorado, School of Medicine, Denver, CO 80220, USA. kagan.ozer@dhha.org
authors.forename: Kagan
authors.initials: K
authors.lastname: Ozer
authors.forename: William
authors.initials: W
authors.lastname: Kramer
authors.forename: Syed
authors.initials: S
authors.lastname: Gillani
authors.forename: Allison
authors.initials: A
authors.lastname: Williams
authors.forename: Wade
authors.initials: W
authors.lastname: Smith
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D017732:Air Ambulances / Q000706:statistics & numerical data*; D000673:Amputation, Traumatic / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D005260:Female; D005383:Finger Injuries / Q000601:surgery*; D006300:Health Services Misuse; D006801:Humans; D008297:Male; D008875:Middle Aged; D010360:Patient Transfer / Q000706:statistics & numerical data*; D012086:Reoperation; D012092:Replantation / Q000706:statistics & numerical data*; D055815:Young Adult