ABSTRACT
Distal replantation is an excellent model to study the results of nerve repair. We aim to demonstrate differences in aesthetic, sensory, and functional outcomes in fingertip replantation, with and without nerve repair. We recruited 28 fingers in 28 patients, who had successful distal replantation in 5 years. Half of the fingers had nerves repaired. Mean follow-up was 39 months. Symptoms of pain, numbness, cold intolerance, scar hypersensitivity, pulp atrophy, and weakness were reported. Nail width, pulp length, 2-point discrimination, Semmes–Weinstein test, and power were evaluated. We used chi-square tests of independence to examine association between nerve repair and symptoms, and independent t tests and Mann–Whitney U tests to analyze difference between replantation with and without nerve repair according to objective results. Chi-square tests reviewed no significant association between nerve repair and symptoms. Mann–Whitney U tests showed no significant difference between the groups, with and without nerve repair. All fingers showed mean 2-point discrimination of 5.6 mm, and Semmes–Weinstein test results of green in 3 fingers and blue in 17. There was no significant difference in overall outcomes in repairing nerve or not in distal finger replantation. Both groups had satisfactory outcomes. Possibly, spontaneous neurotization is present, and nerve repair is not necessary, which may help to shorten the operation time and decrease extensiveness of surgeries.
KEYWORDS
Distal replantation - nerve repair - fingertip sensation
REFERENCES
-
1
Hung L K, Ho K K, Leung P C.
Impairment of hand function and loss of earning capacity after occupational hand injury: prospective cohort study.
Hong Kong Med J.
1999;
5
245-250
-
2
Sorock G S, Lombardi D A, Courtney T K, Cotnam J P, Mittleman M A.
Epidemiology of occupational acute traumatic hand injuries: a literature review.
Saf Sci.
2001;
38
241-256
-
3
Heistein J B, Cook P A.
Factors affecting composite graft survival in digital tip amputations.
Ann Plast Surg.
2003;
50
299-303
-
4
Komatsu S, Tamai S.
Successful replantation of a completely cut off thumb.
Plast Reconstr Surg.
1968;
42
374-377
-
5
Kim W K, Lim J H, Han S K.
Fingertip replantations: clinical evaluation of 135 digits.
Plast Reconstr Surg.
1996;
98
470-476
-
6
Hirase Y M.
Salvage of fingertip amputated at nail level: new surgical principles and treatments.
Ann Plast Surg.
1997;
38
151-157
-
7
Hahn H O, Jung S G.
Results of replantation of amputated fingertips in 450 patients.
J Reconstr Microsurg.
2006;
22
407-413
-
8
Dubert T, Houimli S, Valenti P, Dinh A.
Very distal finger amputations: replantation or “reposition-flap” repair?.
J Hand Surg [Br].
1997;
22
353-358
-
9
Matsuzaki H, Yoshizu T, Maki Y, Tsubokawa N.
Functional and cosmetic results of fingertip replantation: anastomosing only the digital artery.
Ann Plast Surg.
2004;
53
353-359
-
10
Goldner R D, Stevanovic M V, Nunley J A, Urbaniak J R.
Digital replantation at the level of the distal interphalangeal joint and the distal phalanx.
J Hand Surg [Am].
1989;
14(2 Pt 1)
214-220
-
11
Ozerkan F, Ada S, Bora A, Kaplan I, Ademoglu Y.
Eight years experience in crush and avulsion type finger amputation.
Microsurgery.
1995;
16
739-742
-
12
Tokio K, Yuiji O, Tomofumi K et al..
Significance of clinical path in replantation of crush-avulsion fingertip amputation: new surgical classification and postoperative management.
J Jap Ortho Assoc.
2006;
80
S29
-
13
Akyürek M, Safak T, Keçik A.
Fingertip replantation at or distal to the nail base: use of the technique of artery-only anastomosis.
Ann Plast Surg.
2001;
46
605-612
-
14
Matsuzaki H, Yoshizu T, Maki Y, Tsubokawa N.
Functional and cosmetic results of fingertip replantation: anastomosing only the digital artery.
Ann Plast Surg.
2004;
53
353-359
-
15
Yamano Y.
Replantation of the amputated distal part of the fingers.
J Hand Surg [Am].
1985;
10
211-218
-
16
Faivre S, Lim A, Dautel G, Duteille F, Merle M.
Adjacent and spontaneous neurotization after distal digital replantation in children.
Plast Reconstr Surg.
2003;
111
159-165, discussion 166
-
17
Tamai S.
Twenty years' experience of limb replantation—review of 293 upper extremity replants.
J Hand Surg [Am].
1982;
7
549-556
-
18
Mason M L.
Bunnell S: In Appreciation.
JBJS(Am).
1958;
40
211-213
-
19
L.D.H. Bunnell S 1882-1957.
JBJS(Am).
1957;
39
1409-1411
-
20
Bunnell S.
Surgery of the nerves of the hand.
Surg Gynecol Obstet.
1927;
44
145-152
-
21
Sullivan D J.
Results of digital neurorrhaphy in adults.
J Hand Surg [Br].
1985;
10
41-44
-
22
Wang W Z, Crain G M, Baylis W, Tsai T M.
Outcome of digital nerve injuries in adults.
J Hand Surg [Am].
1996;
21
138-143
-
23
Karaoğuz A, Alp M.
Finger-level avulsion-type injuries.
Microsurgery.
2006;
26
165-170
-
24
Glickman L T, Mackinnon S E.
Sensory recovery following digital replantation.
Microsurgery.
1990;
11
236-242
-
25
Ozcelik I B, Tuncer S, Purisa H et al..
Sensory outcome of fingertip replantations without nerve repair.
Microsurgery.
2008;
28
524-530
Clara WongM.D.
Department of Orthopaedics and Traumatology, Prince of Wales Hospital
Shatin, N.T., Hong Kong 852
Email: clara.wongclara@gmail.com
Email: clarawong@ort.cuhk.edu.hk
