Document Detail


Replantation of finger avulsion injuries: a systematic review of survival and functional outcomes.
MedLine Citation:
PMID:  21463730     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
PURPOSE: Recent studies presenting functional outcomes after replantation of finger avulsion injuries have challenged the historical practice of performing revision amputation for all complete finger avulsion injuries. The aim of this study is to conduct a systematic review of the English literature of replantation of finger avulsion injuries to provide best evidence of survival rates and functional outcomes.
METHODS: A Medline literature search yielded 1,398 studies, using key words "traumatic amputation" or "replantation", with limitation to humans and finger injuries. Inclusion criteria required that studies meet the following requirements: (1) primary data are presented; (2) the study includes at least 5 cases with either complete or incomplete finger avulsion injuries at or distal to the metacarpophalangeal joint; (3) the study presents survival rates, total active arc of motion (TAM), or static 2-point discrimination (2PD) data; (4) data for incomplete and complete avulsions are reported separately; (5) patients are treated with microvascular revascularization or replantation. Survival rates, TAM, and 2PD data were recorded and a weighted mean of each was calculated.
RESULTS: Thirty-two studies met the inclusion criteria. Of these 32 studies, all reported survival outcomes, 13 studies reported TAM (metacarpophalangeal, proximal interphalangeal, and distal interphalangeal), and 9 studies reported sensibility. The mean survival rate for complete finger and thumb avulsions having replantation was 66% (n = 442). The mean TAM of complete finger avulsions after successful replantation was 174° (n = 75), with a large number of patients in the included studies having arthrodesis of the distal interphalangeal joint. The mean 2PD in patients after replantation was 10 mm (n = 32).
CONCLUSIONS: We found that functional outcomes of sensibility and range of motion after replantation of finger avulsion injuries are better than what is historically cited in the literature. The results of this systematic review challenge the practice of performing routine revision amputation of all complete finger avulsion injuries.
Authors:
Erika Davis Sears; Kevin C Chung
Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't; Research Support, U.S. Gov't, Non-P.H.S.; Review    
Journal Detail:
Title:  The Journal of hand surgery     Volume:  36     ISSN:  1531-6564     ISO Abbreviation:  J Hand Surg Am     Publication Date:  2011 Apr 
Date Detail:
Created Date:  2011-04-05     Completed Date:  2011-08-12     Revised Date:  2014-09-08    
Medline Journal Info:
Nlm Unique ID:  7609631     Medline TA:  J Hand Surg Am     Country:  United States    
Other Details:
Languages:  eng     Pagination:  686-94     Citation Subset:  IM    
Copyright Information:
Copyright © 2011 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.
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MeSH Terms
Descriptor/Qualifier:
Amputation, Traumatic / diagnosis,  surgery*
Female
Finger Injuries / diagnosis,  surgery*
Fingers / blood supply,  surgery
Graft Survival
Humans
Male
Microcirculation / physiology
Microsurgery / methods
Postoperative Complications / epidemiology,  physiopathology
Prognosis
Range of Motion, Articular / physiology*
Recovery of Function
Regional Blood Flow / physiology
Replantation / adverse effects,  methods*
Risk Assessment
Treatment Outcome
Wound Healing / physiology
Grant Support
ID/Acronym/Agency:
K24 AR053120/AR/NIAMS NIH HHS; K24 AR053120-01A2/AR/NIAMS NIH HHS; K24AR053120/AR/NIAMS NIH HHS
Comments/Corrections

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