Abstract
Background: Single index finger replantation is often listed as a contraindication due to its hindrance of hand function when replanted. Recent studies demonstrate comparable subjective and global functional outcomes for index flexor zone II finger replants versus revision amputations. We therefore sought to identify current opinions of plastic surgery trainees and staff treating single index finger zone II amputations including influential patient and injury characteristics. Methods: With the approval of the Canadian Society of Plastic Surgery, a 17-question survey was sent via email to all listed members on 3 separate occasions. Participation was voluntary and survey responses were compiled and analyzed using SPSS statistical software. Results: Survey response rate was 38.5%. When asked whether the surgeon would replant a single index digit, flexor zone II, sharp amputation, 55.3% of respondents chose "yes," while 44.7% responded "no." Staff (51.5%) were less likely to replant a single index digit amputation. Likelihood of replant dropped substantially in crush (12.4%) and avulsion (17.1%) injury. Smoking was the most likely patient characteristic to change a surgeon's decision (61.9%). Poor range of motion (77.5%) and patient satisfaction (72.5%) were the most frequently listed reasons not to replant. Conclusion: Among Canadian plastic surgeons, there exists disagreement in how single index flexor zone II amputations should be managed. In review of the literature, these notions and previous teaching around replants highlight many inherent surgeon biases with regard to the merit and value of single digit replantation.
Highlights
Traumatic amputations of the digits are common and occur both in the workplace and at home.[1,2,3] Management of such injuries require decision-making between revision amputation or digit replantation
Questions relating to which injury and patient characteristics might influence a surgeon to replant versus perform revision amputation, along with respondent demographics, were included
The majority of respondents were from Ontario (32.9%), while minority of responses came from Manitoba (2.6%), Saskatchewan (2.6%), and New Brunswick (1.8%)
Summary
Traumatic amputations of the digits are common and occur both in the workplace and at home.[1,2,3] Management of such injuries require decision-making between revision amputation or digit replantation. While digit replant survival has improved over the decades, functional outcomes of flexor zone II injuries have historically been poor, typified by tendon adhesions, bony non-union, and poor sensory return.[4,5,6,7,8] A study by White “Why I hate the Index finger,” published in 1980, highlights the limitations of index replants.[5] In it, he entertainingly expresses, “After sustaining an inconsequential injury as a result of its own arrogance, it will refuse to perform regardless of circumstances Does it refuse to function, it interferes with the uninjured parts of the hand engaging in useful activity. In review of the literature, these notions and previous teaching around replants highlight many inherent surgeon biases with regard to the merit and value of single digit replantation
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