There is no financial information to disclose. Comparative evidence regarding outcomes, benefits, and limitations of digit amputation treatment is minimal. The study aim was to compare the differences in long-term patient reported outcomes (PROs) and functional outcomes between patients treated with revision amputation or replantation. We hypothesize that patients treated with replantation would report superior appearance whereas patients treated with revision amputation would report less pain and earlier return to work compared with patients who underwent replantation. Participants were enrolled in accordance with predetermined eligibility criteria at 22 participating sites in (Finger Replantation and Amputation Challenges in Assessing Impairment, Satisfaction and Effectiveness (FRANCHISE) across the United States and internationally. Enrolled participants (age >18 years) had a traumatic digit amputation up to 5 years prior to the assessment time. We evaluated PROs [the Michigan Hand Outcomes Questionnaire (MHQ), the Disabilities of the Arm, Shoulder, and Hand, (DASH), the 36-item Short Form survey (SF-36), and the Patient-Reported Outcomes Measurement Information System (PROMIS) upper-extremity module] and functional measures (grip strength, lateral pinch, 2-point and 3-point pinch strength, and 9-hole peg test). Statistical analysis included comparison of means with nonparametric tests. FRANCHISE enrolled a total of 323 participants, 170 of whom were treated with replantation and 153 of whom were treated with revision amputation. Study participants treated with replantation and revision amputation had significantly different scores on MHQ, DASH, and PROMIS (P values < .0001, < .007, and < .0001, respectively. (Table 66-1). Further analysis showed that patients treated with replantation for a single finger, but not the thumb, had significantly higher scores on these PROs (P values = .006, .004, <.001 respectively). For functional outcomes, grip strength, 2-point pinch, and 3-point pinch strengths were significantly different between various subgroups (P values = .005, .4, .0005, respectively) (Table 66-2). Patients treated with revision amputation for the thumb only had significantly higher grip strength compared with other groups (P = .0007). •Digit replantation yielded improved function and work ability for replanted individuals.•Patients with digit replantation had less pain and better appearance, performed their activities of living easier, and had improved satisfaction compared with patients who received revision amputation.•The FRANCHISE collaboration has led to an NIH grant proposal Finger Replantation and Amputation Multicenter (FRAM) study to guide treatment choice for each group of digit amputation.Table 66-1Patient-Reported Outcomes after Digit Revision amputation or Replantation in FRANCHISE study participantsGroupMHQ (Mean ± SD)DASH (Mean ± SD)SF-36 PCS (Mean ± SD)SF-36 MCS (Mean ± SD)PROMIS (Mean ± SD)Revision Amputation Multiple finger, including thumb65 ± 1931 ± 2548 ± 958 ± 836 ± 9 Multiple finger, not thumb70 ± 2119 ± 1851 ± 851 ± 1065 ± 12 Single finger, not thumb81 ± 1710 ± 1352 ± 853 ± 1074 ± 10 Thumb only78 ± 1210 ± 1253 ± 754 ± 670 ± 8Replantation Multiple finger, including thumb68 ± 2415 ± 1651 ± 848 ± 1567 ± 12 Multiple finger, not thumb70 ± 1816 ± 1852 ± 750 ± 1170 ± 11 Single finger, not thumb82 ± 127 ± 754 ± 652 ± 1077 ± 6 Thumb Only81 ± 1511 ± 1753 ± 753 ± 973 ± 8P Value<.0001*<.007*.15.48<.0001*FRANCHISE – Finger Replantation and Amputation Challenges in Assessing Impairment, Satisfaction, and Effectiveness; MHG-Michigan Hand Outcome Questionnaire: ADL: Activities of Daily Living; DASH – Disabilities of the Arm, Shoulder, and Hand; SF-36 PCS-36 item Short Form survey Physical Component Scale; SF-36 MCS-36 item Short Form survey Mental Component Scale; PROMIS – Patient-Reported Outcomes Measurement Information System; SD- Standard Deviation; *Statistically significant, comparisons were made among all 8 groups. Open table in a new tab Table 66-2Functional Outcomes after Digit Replantation Amputation or Replantation in FRANCHISE Study ParticipantsGroupGrip strength (Mean ± SD)Lateral pinch strength (Mean ± SD)2-point pinch strength (Mean ± SD)3-point pinch strength (Mean ± SD)Revision Amputation Multiple finger, including thumb25 ± 226 ± 55 ± 34 ± 5 Multiple finger, not thumb26 ± 139 ± 46 ± 36 ± 2 Single finger, not thumb33 ± 139 ± 46 ± 37 ± 4 Thumb only39 ± 1010 ± 37 ± 68 ± 2Replantation Multiple finger, including thumb33 ± 2310 ± 67 ± 68 ± 8 Multiple finger, not thumb28 ± 137 ± 35 ± 35 ± 3 Single finger, not thumb34 ± 129 ± 36 ± 37 ± 3 Thumb Only36 ± 149 ± 56 ± 47 ± 6P Value.005*.13.04*.0005*FRANCHISE: Finger Replantation and Amputation Challenges in Assessing Impairment, Satisfaction, and Effectiveness; Grip and pinch strengths measured in Kilogram; Data presented are for injured hand only; *Statistically significant, comparisons were made among all 8 groups. Open table in a new tab FRANCHISE – Finger Replantation and Amputation Challenges in Assessing Impairment, Satisfaction, and Effectiveness; MHG-Michigan Hand Outcome Questionnaire: ADL: Activities of Daily Living; DASH – Disabilities of the Arm, Shoulder, and Hand; SF-36 PCS-36 item Short Form survey Physical Component Scale; SF-36 MCS-36 item Short Form survey Mental Component Scale; PROMIS – Patient-Reported Outcomes Measurement Information System; SD- Standard Deviation; *Statistically significant, comparisons were made among all 8 groups. FRANCHISE: Finger Replantation and Amputation Challenges in Assessing Impairment, Satisfaction, and Effectiveness; Grip and pinch strengths measured in Kilogram; Data presented are for injured hand only; *Statistically significant, comparisons were made among all 8 groups.