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Peng P, Guo Q, Tang Y, Huang Y, Luo L, Wei J, Zheng L. Replantation of digit-tip amputation caused by crush injuries with supermicrosurgery technique. Eur J Trauma Emerg Surg 2024:10.1007/s00068-024-02485-z. [PMID: 38421389 DOI: 10.1007/s00068-024-02485-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Accepted: 02/22/2024] [Indexed: 03/02/2024]
Abstract
PURPOSE Digit-tip amputation caused by crush injury is a common emergency scenario, and the management is full of challenges. The objective of this study was to demonstrate the application of the supermicrosurgery technique in replantation procedures for complex digit-tip amputations resulting from crush injuries, while also assessing functional and aesthetic outcomes. METHODS We conducted a retrospective analysis of the data from 12 patients who underwent replantation of 15 digits in our department between July 2022 and June 2023. The outcomes of replantation, functional recovery (including return to work, cold tolerance, bone union, DASH score, VAS score, and two-point discrimination test), aesthetic results (including digit appearance, nail deformity, and pulp atrophy), and patient satisfaction were assessed. RESULTS The amputation of 7 digits occurred within Tamai zone I level, 8 digits within Tamai zone II level, while 4 digits occurred within Ishikawa zone I level, 3 digits within Ishikawa zone II level, 7 digits within Ishikawa zone III level, and 1 digit within Ishikawa zone IV level. The replanted digits all survived (100%) without any indications of arterial insufficiency or venous congestion. The follow-up procedures were conducted on all 12 patients, with an average duration of 9.6 months (range, 6 to 18 months). The fracture successfully underwent healing at 9.2 weeks (range, 8 to 13 weeks). The mean VAS score was 1.75 points (range 0 to 4 points), the mean two-point discrimination test result was 5.72 mm (range 4.0 to 7.0 mm), and the mean DASH score was 9.78 points (range 3.33 to 22.5 points). All patients demonstrated cold tolerance and successfully resumed their pre-injury occupational activities. The nail deformity was observed in one digit following replantation within Tamai zone I, and in three digits following replantation within Tamai zone II; moreover, eight digits exhibited varying degrees of pulp atrophy. All patients expressed satisfaction with both functional and aesthetic outcomes. CONCLUSION The successful replantation of digit-tip amputation caused by crush injury can be achieved through the application of supermicrosurgery technique, resulting in improved functional and aesthetic outcomes. Digit-tip replantation is a favorable and meaningful procedure with high patient satisfaction.
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Affiliation(s)
- Ping Peng
- Department of Orthopedics, The Third Xiangya Hospital, Central South University, No. 138, Tongzipo Road, Changsha, 410013, Hunan, People's Republic of China
| | - Qiang Guo
- Department of Orthopedics, The Third Xiangya Hospital, Central South University, No. 138, Tongzipo Road, Changsha, 410013, Hunan, People's Republic of China
| | - Yifu Tang
- Department of Orthopedics, The Third Xiangya Hospital, Central South University, No. 138, Tongzipo Road, Changsha, 410013, Hunan, People's Republic of China
| | - Yuzhao Huang
- Department of Orthopedics, The Third Xiangya Hospital, Central South University, No. 138, Tongzipo Road, Changsha, 410013, Hunan, People's Republic of China
| | - Ling Luo
- Department of Orthopedics, The Third Xiangya Hospital, Central South University, No. 138, Tongzipo Road, Changsha, 410013, Hunan, People's Republic of China.
| | - Jianwei Wei
- Department of Orthopedics, The Second Xiangya Hospital, Central South University, No. 139 Renmin Road, Changsha, 410011, Hunan, People's Republic of China
| | - Lei Zheng
- Department of Orthopedics, Henan Provincial People's Hospital, Zhengzhou, 450003, Henan, People's Republic of China
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Practical Techniques to Ensure Success in Digital Ring Avulsion Injuries. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2021; 9:e3771. [PMID: 34667701 PMCID: PMC8517313 DOI: 10.1097/gox.0000000000003771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 06/29/2021] [Indexed: 11/25/2022]
Abstract
A ring avulsion results from a longitudinal traction to a digit. We discuss practical microsurgical techniques essential in achieving good functional outcomes in these challenging cases, including aggressive debridement of the affected tissues and vessels, liberal use of vein grafts and arterialized venous flow through flaps when needed, and a meticulous microsurgical technique. We have found that patient selection is key in digit salvage and a good outcome is often achieved with the winning triad of optimal patient factors, surgical factors, and intensive hand therapy. We also include a case performed by our senior author to illustrate what can be achieved.
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