gms | German Medical Science

Objectives/Interrogation: There are only relative indications for distal digital replantation in zones 1 and 2 according to Tamai. Replantation is a complex procedure that requires skills in supermicrosurgical techniques, a longer hospital stay and the longer time off from work. On the opposite side a conservative treatment with local flap, in order to avoid further finger shortening, offer to the patient an easier course of treatment and healing. The aim of the present retrospective study is to make a comparison in terms of final functional and cosmetical result between reconstructed and replanted finger tip.

Methods: The study included 20 patients who underwent replantations distal to the distal interphalangeal joint or conservative reconstruction meaning direct closure with local flap. Lesion involved zone 1 and 2 according to Tamai classification. In case of replantation arterial anastomosis was accomplished after bone fixation, and venous anastomosis and nerve repair were performed whenever possible. When venous anastomosis was not possible, venous decompression was performed with heparinized gauze placed on the bleeding nail matrix. In case of conservative treatment patients were treated with local finger flaps in order to mantain bone lenght on distal phalanx. Functional and cosmetical results were evaluate at least after one year with test Semmens Weinstein monofilament, Weber Disk Criminator, total range of motion and quickDASH. Data were statistical analysed with t-Student test.

Results and Conclusions: All patient healed with no necessity of further operation on long time. All of them went to post-operative rehabilitation protocol. Functional, cosmetical outcome and sensibility result are presented and compared in respect of objective and subjective patient's daily need and quality of life.

Distal digital replantation is complex and technically challenging, the treatment is more demanding both for surgeon and patient if compared to a local flap. A correct analysis of patient need and an exhaustive explanation of all the potential risk and complication of two different approach is fundamental. Even if one could think that a missing finger tip is not so invalidating, long time results, the high patient gratification and the greater functional limitations of a local flap, justify the replantation attempt.