Digit replantation: Experience of two U.S. Academic level-i trauma centers

Background: Despite advances in microsurgery digit replantation now is performed less frequently in the U.S. compared with fifteen years ago. There has been uncertainty regarding whether previously reported U.S. replantation success rates and results reported from other countries reflect the current experience in the U.S. We hypothesized that the success of digit replantation at two academic level-I referral hospitals in the U.S. would be similar to previously published results. Methods: In this retrospective case series we examined all cases of digit replantation that were performed from 1997 through 2010 at two institutions. The cumulative rate of viable digit replantations was determined. Binary logistic regression modeling determined the relative impact of patient injury and operative factors on replantation survival. Results: During the study period 135 digit replantations were performed in 106 patients. Fourteen cases did not meet our inclusion criteria yielding a cohort of 121 replantations. The thumb (n = 40) was the most commonly replanted digit followed by the long finger (n = 31). The mechanism of injury was classified as sharp in eighty-three digits crush in nineteen digits and avulsion in eighteen digits. The majority of replantations were performed following Tamai level-III (n = 49) or level-IV (n = 56) amputations. Sixty-nine (57%) of the digit replantation procedures were successful. Logistic regression analysis identified replantation of the radial three digits and no history of tobacco use as significant independent predictors of replantation success. Conclusions: The rate of success of digit replantation (57%) at two academic level-I trauma hospitals was lower than previously published rates. Radial-digit involvement and no prior tobacco use were associated with replantation success. This modest success rate reflects a need for additional evaluation of our current benchmarks and clinical settings for replantation surgery. These data help to better inform patients families and physicians who are considering digit replantation. Level of Evidence: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence. COPYRIGHT