title: Replantation and revascularization vs. amputation in injured digits.
abstract: BACKGROUND
  The purpose of this study was to analyze factors associated with the decision to replant or revascularize rather than amputate an injured digit as well as factors associated with successful replantation or revascularization.
  
  
  METHODS
  We reviewed 315 complete and subtotal amputations at or proximal to the distal interphalangeal joint in 199 adult patients treated over 10 years. Ninety-three digits were replanted (30 %), 51 were revascularized (16 %), and 171 were amputated (54 %), including 5 attempted replantations. Bivariate and multivariable analyses sought factors associated with replantation vs. amputation, revascularization vs. amputation, and success of replantation or revascularization.
  
  
  RESULTS
  Factors associated with replantation rather than amputation were injury to the left hand, thumb, middle digit, and ring digit, more than one digit affected, and surgeon. Factors associated with revascularization are surgeon and shorter ischemia time. Forty-five replantations (48 %) and 41 revascularizations (80 %) were successful. Successful replantation was associated with the side of injury (left side more likely to survive), zone of injury (distal interphalangeal and interphalangeal joint more likely to survive and proximal phalanx less likely to survive), and shorter ischemia time. Success of revascularization was associated with the mechanism of injury (saw and not crush injury), multiple digits involved, and the surgeon.
  
  
  CONCLUSIONS
  The decision to replant, revascularize, or amputate a nonviable digit and the success of replantation and revascularization are related to both injury factors, such as mechanism of injury, affected digit, and zone of injury, and the surgeon.
authors.affiliation: MGH Hand Service, Yawkey Center, Massachusetts General Hospital, Suite 2100, 55 Fruit Street, Boston, MA 02114 USA.
authors.forename: Marjolein A M
authors.initials: MA
authors.lastname: Mulders
authors.affiliation: MGH Hand Service, Yawkey Center, Massachusetts General Hospital, Suite 2100, 55 Fruit Street, Boston, MA 02114 USA.
authors.forename: Valentin
authors.initials: V
authors.lastname: Neuhaus
authors.affiliation: MGH Hand Service, Yawkey Center, Massachusetts General Hospital, Suite 2100, 55 Fruit Street, Boston, MA 02114 USA.
authors.forename: Stéphanie J E
authors.initials: SJ
authors.lastname: Becker
authors.affiliation: MGH Hand Service, Yawkey Center, Massachusetts General Hospital, Suite 2100, 55 Fruit Street, Boston, MA 02114 USA.
authors.forename: Sang-Gil
authors.initials: SG
authors.lastname: Lee
authors.affiliation: MGH Hand Service, Yawkey Center, Massachusetts General Hospital, Suite 2100, 55 Fruit Street, Boston, MA 02114 USA.
authors.forename: David C
authors.initials: DC
authors.lastname: Ring
keywords: Amputation; Replantation; Revascularization; Success; Traumatic