Predictors of Hand Dexterity after Single-Digit Replantation.

Abstract

Microsurgical replantation of the thumb and digits has become an increasingly familiar technique in clinical practice worldwide. However, successful digit replantation does not always provide better hand function than revision amputation. Little information is available regarding predictors of motor skill activities of replanted hands. Therefore, we retrospectively evaluated hand dexterity after single-digit replantation at a minimum follow-up of 1 year and analyzed the factors influencing dexterity. This retrospective cohort study included 23 patients treated for amputation injuries at our institution from 2014 to 2015. Patients with amputations from Tamai's zone 2 to 5 of the thumb (3 patients), index finger (11 patients), or middle finger (9 patients) who underwent digital replantation surgery and were followed up for more than 1 year were included. Follow-up evaluations were conducted at an average of 23 months postoperatively (range: 13-25 months). We hypothesized that possible factors influencing hand dexterity after single-digit replantation were patient age, injured finger, key pinch strength, Semmes-Weinstein test result, and percentage of total active motion. Relationships between the outcome variable, which was the result of the Purdue Pegboard Test of hand dexterity, and explanatory variables were analyzed using Spearman's correlation coefficient. A p-value of < 0.05 indicated statistical significance. No postoperative complications occurred. Univariate analysis indicated that decreased hand dexterity after single-digit replantation was significantly associated with older age (p = 0.001) and poor recovery of sensation, as shown by the Semmes-Weinstein test (p = 0.012). Patient age was a risk factor for low hand dexterity after replantation surgery. Recovery of finger sensitivity enhanced dexterity of motor skill activities following finger replantation surgery.