title: Factors affecting healing and survival after finger amputations in patients with digital artery occlusive disease.
abstract: BACKGROUND
  Finger amputations are typically performed as distal as possible to preserve maximum finger length. Failure of primary amputation leads to additional procedures, which could potentially be avoided if a more proximal amputation was initially performed. The effect of single versus multiple procedures on morbidity and mortality is not known. We evaluated factors that predicted primary healing and the effects of secondary procedures on survival.
  
  
  METHODS
  Patients undergoing finger amputations from 1995 to 2011 were evaluated for survival with uni- and multivariate analysis of demographic data and preoperative vascular laboratory studies to assess factors influencing primary healing.
  
  
  RESULTS
  Seventy-six patients underwent 175 finger amputations (range 1 to 6 fingers per patient). Forty-one percent had diabetes, 33% had nonatherosclerotic digital artery disease, and 29% were on dialysis. Sex distribution was equal. Primary healing occurred in 78.9%, with the remainder requiring revisions. By logistic regression analysis, nonatherosclerotic digital artery disease was associated with failure of primary healing (odds ratio = 7.5; 95% confidence interval, 1.03 to 54; P = .047). Digital photoplethysmography did not predict primary healing. The overall healing of primary and secondary finger amputations was 96.0%. The mean survival after the initial finger amputation was 34.3 months and did not differ between patients undergoing single (35.6 months) versus multiple procedures (33.6 months). Dialysis dependence was associated with decreased survival (hazard ratio = 2.9; 95% confidence interval, 1.13 to 7.25; P = .026).
  
  
  CONCLUSIONS
  Failure of primary healing is associated with the presence of nonatherosclerotic digital artery disease and is not predicted by digital photoplethysmographic studies. Dialysis dependence is associated with decreased survival in patients with finger amputations, but failure of primary healing does not adversely affect survival. A strategy of aggressive preservation of finger length is appropriate for most patients.
authors.affiliation: Knight Cardiovascular Institute, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Mail Code OP11, Portland, OR 97239-3098, USA. landryg@ohsu.edu
authors.forename: Gregory J
authors.initials: GJ
authors.lastname: Landry
authors.forename: Ashley
authors.initials: A
authors.lastname: McClary
authors.forename: Timothy K
authors.initials: TK
authors.lastname: Liem
authors.forename: Erica L
authors.initials: EL
authors.lastname: Mitchell
authors.forename: Amir F
authors.initials: AF
authors.lastname: Azarbal
authors.forename: Gregory L
authors.initials: GL
authors.lastname: Moneta
mesh_terms: D000328:Adult; D000671:Amputation, Surgical / Q000401:mortality; D001157:Arterial Occlusive Diseases / Q000209:etiology / Q000401:mortality / Q000601:surgery*; D003925:Diabetic Angiopathies / Q000401:mortality / Q000601:surgery; D005260:Female; D005385:Fingers / Q000098:blood supply* / Q000601:surgery; D006801:Humans; D007511:Ischemia / Q000209:etiology / Q000401:mortality / Q000601:surgery*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D006435:Renal Dialysis; D051436:Renal Insufficiency, Chronic / Q000150:complications / Q000628:therapy; D012086:Reoperation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D012307:Risk Factors; D016019:Survival Analysis; D016896:Treatment Outcome; D014945:Wound Healing