gms | German Medical Science

Objectives/Interrogation: To achieve satisfactory results in replantation of complete finger avulsion injury remains to be a great challenge. The aim of this study was to assess the outcomes of a series of procedure including microscopic debridement, nerve and vein graft, and tendon transposition in replantation of complete finger avulsion.

Methods: A total of 32 cases with complete avulsed fingers injuries in the past 15 years were included. The mean follow-up period was 5.1 years. Microscopic debridement was performed in all cases. Tendon transposition was performed when the tendon lacerated from muscle belly. Arterial defect was bridged by vein graft from foot. Nerve laceration was trimmed to expose normal nerve papilla and bridged by autologous cutaneous nerve graft. The total active range of motion, sensation, pain, cold intolerance, and percussion tenderness of the digits was assessed. Patient satisfaction with the aesthetic outcome was assess by using the Michigan Hand Outcomes Questionnaire.

Results and Conclusions: The complete survival rate of replantation was 87.5%. Partial necrosis occurred in the left 3 cases, which was repaired by secondary flap transfer. The replanted digits had a mean static 2-point discrimination of 7.8 mm (6 -14 mm), a mean total active range of motion of 185°, and a mean grip strength of 27.4 kg. A total of 53% digits had mild cold intolerance. Only 3 patients reported mild percussion tenderness. A total of 90.6% of the patients were satisfied with the appearance of the reconstructed fingertips.

In conclusion, microscopic debridement was essential to check the tissue status after complete avulsion injury and create the condition for anastomosing. Primary nerve and vein graft, as well as tendon transposition, was advocated to achieve high survival rate and functional outcomes.