Arch Hand Microsurg.  2019 Mar;24(1):68-73. 10.12790/ahm.2019.24.1.68.

Predictors of Survival Rate in Fingertip Replantation

• Lee TK
• Choi JH
• Yang TY
• Woo SH

• KMID: 2440614
• DOI: http://doi.org/10.12790/ahm.2019.24.1.68

Abstract

PURPOSE
To evaluate the variable factors affecting the survival rate in fingertip replantation.
METHODS
We have performed 640 replantation cases of amputation distal to the distal interphalangeal joint between January 2010 to June 2018. Retrospectively, patients were analyzed about variable factors (age, sex, injury mechanism, amputation level according to Ishikawa subzone, ischemic time, surgical experience, vein anastomosis, vein graft) affecting the survival rate of fingertip replantation.
RESULTS
The overall survival rate was 76.9% (492 of 640). Male patients were more than female (511 of 640, 79.8%), but survival rate of female was higher than male (80.6%). The mean age of patients was 45.3 years old (15 months to 76 years). In the level of injury, amputation of distal phalanx was most frequently occurred at Ishikawa subzone I (167 of 640). Survival rate of subzone I (80.8%) and II (85.8%) was higher than subzone III (72.4%) and IV (66.8%). In the type of injury, local crushing injury (345 of 640) was most common cause of amputation. And severe crushing injury (66.5%) was the lowest survival rate than others; guillotine (87.0%) and local crushing (80.3%). Total ischemic time was 631 minutes. Ischemic time was not statistically significant. There was a higher survival rate for vein anastomosis group (77.9%) than salvage group (66.4%) in Ishikawa subzone III and IV. The success rate of fingertip replantation is getting higher with experience of hand surgeons.
CONCLUSION
The factors of age, sex, and ischemic times do not affect the survival rate of fingertip replantation. The level of injury, injury mechanism, vein anastomosis, vein graft, surgical experience of the surgeons are statistically significant factors for the survival rate of fingertip replantation.

Keyword

Replantation; Survival rate

MeSH Terms

Amputation
Female
Hand
Humans
Joints
Male
Operative Time
Replantation*
Retrospective Studies
Surgeons
Survival Rate*
Transplants
Veins

Figure

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  Fig. 1 (A) Level of fingertip amputation according to the Ishikawa classification. (B) Pulp amputation is defined as a soft tissue injury only not involving distal phalangeal bone.

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  Fig. 2 Survival rate in fingertip replantation based on the yearly experiences of hand specialists (p<0.05).

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