title: Traumatic Finger Amputation Treatment Preference among Hand Surgeons in the United States and Japan.
abstract: BACKGROUND
  Large geographic differences in procedure utilization draw into question its appropriate use. In Japan, replantation is frequent for even very distal finger amputations. In the United States, revision amputation is far more common. There has been no detailed investigation into the drivers of these differences.
  
  
  METHODS
  The authors created a survey to assess experience with replantation, estimates of physical and functional outcomes, attitudes toward amputees, and preferences in several injury scenarios. The survey was distributed to members of the Finger Replantation and Amputation Multicenter Study and to hand surgeons making podium presentations at the Thirty-Second Annual Meeting of the Central Japanese Society for Surgery of the Hand.
  
  
  RESULTS
  One hundred percent of both groups responded. There were no significant differences in surgeon experience. Japanese surgeons were significantly more likely to recommend replantation in all scenarios, despite 62 percent ranking function 6 months after replantation as "poor." Japanese surgeons also rated the appearance of a hand with an amputated finger significantly poorer. Finally, Japanese surgeons were significantly more likely to report stigmatization against finger amputees.
  
  
  CONCLUSIONS
  There is no study with a high level of evidence comparing outcomes following replantation and revision amputation. The lack of evidence results in surgeons basing recommendations on personal preference. In this case, Japanese surgeons preferred replantation despite agreeing that functional outcomes were suboptimal. This may be because of Japanese cultural beliefs. Comparative effectiveness research, such as that planned by the Finger Replantation and Amputation Multicenter Study, can provide evidence toward the appropriate use of replantation.
authors.affiliation: Ann Arbor, Mich.; and Nagoya, Japan.|From the Section of Plastic Surgery, Department of Surgery, University of Michigan Medical School; the Department of Hand Surgery, Nagoya University Graduate School of Medicine.
authors.forename: Melissa J
authors.initials: MJ
authors.lastname: Shauver
authors.affiliation: Ann Arbor, Mich.; and Nagoya, Japan.|From the Section of Plastic Surgery, Department of Surgery, University of Michigan Medical School; the Department of Hand Surgery, Nagoya University Graduate School of Medicine.
authors.forename: Takanobu
authors.initials: T
authors.lastname: Nishizuka
authors.affiliation: Ann Arbor, Mich.; and Nagoya, Japan.|From the Section of Plastic Surgery, Department of Surgery, University of Michigan Medical School; the Department of Hand Surgery, Nagoya University Graduate School of Medicine.
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Hirata
authors.affiliation: Ann Arbor, Mich.; and Nagoya, Japan.|From the Section of Plastic Surgery, Department of Surgery, University of Michigan Medical School; the Department of Hand Surgery, Nagoya University Graduate School of Medicine.
authors.forename: Kevin C
authors.initials: KC
authors.lastname: Chung
mesh_terms: D000328:Adult; D000368:Aged; D000673:Amputation, Traumatic / Q000601:surgery*; D001291:Attitude of Health Personnel; D005260:Female; D005383:Finger Injuries / Q000601:surgery*; D019538:Health Care Surveys; D006801:Humans; D007564:Japan; D008297:Male; D008875:Middle Aged; D012092:Replantation; D066231:Surgeons / Q000523:psychology*; D011795:Surveys and Questionnaires; D014481:United States