A Comparison of Functional Outcomes and Therapeutic Costs: Single Digit Replantation versus Revision Amputation.

Background: The functional outcomes and therapeutic costs between digit replantation and revision amputation has remained controversial. Methods: Total 1023 patients with single digit traumatic amputation or devascularization who received successful digit replantation (failure excluded) or revision amputation from 1 January 2013 to 1 January 2016 were included in this study. All cases were subgrouped based on Tamai level of amputation and injured fingers. The Clinical outcomes were assessed by Michigan hand outcomes questionnaire (MHQ) one year after the initial surgery. We also compared the cost of treatment, the duration of hospitalization and sick leave between the two treatments. Results: Replantation of small (level I - V), ring (level I - III) and long (level I) fingers showed no functional benefit compared with initial revision amputation. In contrast, replantation of thumb (level I-V), index (I-V), long (II-V) and ring (IV-V) fingers had better outcomes. The cost of replantation was higher and the duration of hospitalization and sick leave of replantation were also longer compared with revision amputation group. Conclusions: Single amputated injuries of small (level I - V), ring (level I - III) and long (level I) fingers are a relative contradiction for replantation. Replantation of thumb (level I-V), index (I-V), long (II-V) and ring (IV-V) fingers showed extra benefit compared with revision amputation. (C)2017American Society of Plastic Surgeons