Digital replantation seems better than revision amputation

(HealthDay)—For patients with a distal single finger or three or more digits amputated, patient-reported outcomes (PROs) seem better with replantation versus revision amputation, according to a study published online April 17 in JAMA Surgery.

Kevin C. Chung, M.D., from the University of Michigan Medical School in Ann Arbor, and colleagues conducted a retrospective cohort study at 19 centers involving 338 individuals aged 18 years or older with revision amputation or replantation of traumatic digital amputations.

In the adjusted aggregate comparison of PROs, the researchers found significantly better outcomes in the replantation versus revision amputation cohort as measured by the Michigan Hand Outcomes Questionnaire (MHQ; 5.93), Disabilities of the Arm, Shoulder, and Hand (DASH; −4.29), and Patient-Reported Outcomes Measurement Information System (PROMIS; 3.44) scores. After replantation, DASH scores were significantly lower (6 versus 9), indicating less disability and pain, and PROMIS scores were significantly higher (78 versus 75). Significantly better PROs were reported after replantation versus revision amputation for patients with three or more digits amputated (22 versus 42 for DASH; 61 versus 36 for PROMIS); MHQ scores were higher after replantation but not significantly. In single-finger amputation distal to the proximal interphalangeal joint, revision amputation resulted in better 2-point discrimination (6 versus 8 mm).

"A national traumatic digit injury management guideline that clearly delineates patients who may have better outcomes with replantation versus revision amputation is required to optimize patient outcomes," the authors write.

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