Digital replantation at the level of the distal interphalangeal joint and the distal phalanx.

Forty-two complete, single digit amputations at the level of the distal interphalangeal joint or distal phalanx are reviewed. Viability was 81%. Operative time averaged 4.6 hours. Average age of patients was 28 years and 90% were male. Forty-eight percent of the amputations involved the thumb; 79% were at the distal interphalangeal joint and 21% were more distal. One artery was repaired in 64% of replantations, two or three veins were repaired in 61%, and veins grafts were used in 19% of cases. Sixty-nine percent of the crush-avulsion injuries succeeded compared with 89% of lacerations. Two-point discrimination averaged 10 mm and proximal interphalangeal motion averaged 91 degrees. Patients returned to work an average of 2.5 months after replantation and none required additional procedures. The average total cost of treatment was $7500.00. Compared with conventional procedures, disadvantages of replantation at or distal to the distal interphalangeal joint are that it does require microsurgical training, initial operating time is longer, and it is more expensive. Advantages are that it is a one-stage procedure that gives good distal soft tissue coverage, adequate sensibility without painful neuroma, good metacarpophalangeal and proximal interphalangeal joint motion; it preserves the nail, maintains digit length, is cosmetically pleasing, and the patient is satisfied.