Arch Hand Microsurg.  2020 Dec;25(4):297-303. 10.12790/ahm.20.0057.

Analysis of Outcomes of Tamai Zone I Digital Replantation in Cases of Severe Crushing Injury

• Hong MK
• Park J
• Koh SH
• Lee DC
• Roh SY
• Lee KJ
• Kim JS

• KMID: 2508944
• DOI: http://doi.org/10.12790/ahm.20.0057

Abstract

Purpose
Digital replantation has dramatically changed the fate of mutilated injuries of hand. But in case of severe crushing injury in Tamai zone I, it is a contraindication of replantation. This study aims to determine the replantation survival rate in cases with crushing injury.
Methods
We retrospectively evaluated patients’ charts and photos from January 2015 to December 2019. There were 294 patients (331 fingers) with digital amputation who underwent surgery. Cases with crushing were divided into petechiae-in-skin group and red-line-sign group and compared with the group without crushing. The relationship of survival rate with factors was evaluated using chi-square analysis.
Results
Of these, 199 fingers were defined as severe crushed, and 140 cases with petechiae in skin and 59 cases with red line sign. There was no statistically significant difference in survival rate compared with the group without crushing (p=0.227). Additional surgery was performed more in crushed injury. However, necrotized soft tissue was mainly on margin of amputation, not on crushed area.
Conclusion
The presence of crushing did not affect survival rate in Tamai zone I replantation. However, as the degree of crushing was severe, the need for additional surgery increased. We found that the number of anastomosed arteries and veins influences the survival rate. According to our analysis, even if it’s difficult, finding and doing anastomosis as many vessels as possible can make good results.

Keyword

Zone I; Replantation; Crushed

Figure

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  Fig. 1. (A) Group I, clean-cut injury without crushing. (B) Group II, partially crushed amputee with petechiae on skin. (C) Group III, severely crushed amputee with red line sign suggesting vessel damage.

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  Fig. 2. A 32-year-old patient presented with an amputation of right middle finger cut by knife. (A) Three weeks after surgery, the patient was discharged without additional surgery. (B) Follow-up image was taken 6 months after the surgery.

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  Fig. 3. A 38-year-old patient presented with an amputation of right middle and ring finger pressed by hydraulic machine. (A) Both amputees were severely crushed including red line sign. (B) Most of the necrotized tissue was located at the margin. (C) Split-thickness skin graft was performed on both fingers. (D) Follow-up image was taken 6 months after the surgery.

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  Fig. 4. A 3-year-old patient presented with an amputation of right ring finger stuck by folding chair. (A) Amputee was mildly crushed including some petechiae. (B) Very rarely, necrotized tissue was mainly in the area where petechia was checked, not the margin. (C) Full-thickness skin graft was performed on the defect. (D) Follow-up image was taken a week after the surgery (after removing tie-over dressing).

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