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Replantation of traumatic digit amputation may improve outcomes vs revision amputation
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Results showed replantation may improve patient-reported outcomes among those with thumb, distal single-finger, or three or more-finger amputation compared with revision amputation.
In a retrospective cohort study of 338 patients with traumatic digit amputation who underwent either revision amputation or replantation, Kevin C. Chung, MD, MS, and colleagues collected the Michigan Hand Outcomes Questionnaire score as the primary outcome. Researchers also collected the SF-36, DASH and Patient-Reported Outcomes Measurement Information System (PROMIS) upper-extremity module scores and functional outcomes as secondary outcomes.
Results showed outcomes measured by the Michigan Hand Outcomes Questionnaire, DASH and PROMIS scores were significantly better in the replantation cohort in an adjusted aggregate comparison between patients with revision amputation and replantation. Subgroup analysis showed that patients who underwent replantation had significantly lower DASH scores, which researchers noted indicated less disability and pain, and higher PROMIS scores. Researchers found significantly better patient-reported outcomes after replantation among patients with three or more digits amputated including the thumb, as well as higher Michigan Hand Outcomes Questionnaire scores in patients who underwent replantation after three or more-digit amputation excluding the thumb. Patients with single-finger amputation distal to the proximal interphalangeal joint had better two-point discrimination with revision amputation, according to results. However, researchers noted replantation resulted in better nine-hole peg test times in patients with three or more digits amputated including the thumb. Researchers also found replantation resulted in better Semmes-Weinstein monofilament test and better three-point pinch tests among patients with three or more digits amputated excluding the thumb and patients with two digits amputated excluding the thumb, respectively.
“Given the improved [patient-reported outcomes] PROs after replantation compared to revision amputation, we recommend replantation for three or more-finger amputation and distal single-finger amputations. Thumb amputations should still be replanted when technically feasible given its integral role in hand function and opposition,” Chung told Healio.com/Orthopedics. “Based on these findings, we hope to formulate a comprehensive guideline for digit amputation management and underscore the indications for replantation that lead to optimal outcomes. Both surgeons and payers should critically assess the role of replantation in traumatic digit amputations.” – by Casey Tingle
Disclosures: Chung reports he receives grants from the National Institute of Arthritis and Musculoskeletal and Skin Diseases of the NIH. Please see the full study for a list of all other authors’ relevant financial disclosures.
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Chung KC, et al. JAMA Surg. 2019;doi:10.1001/jamasurg.2019.0418.
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