Kevin C Chung1, Alfred P Yoon2, Sunitha Malay2, Melissa J Shauver2, Lu Wang3, Surinder Kaur4. 1. Section of Plastic Surgery, Department of Surgery, University of Michigan Medical School, Ann Arbor. 2. Section of Plastic Surgery, Department of Surgery, University of Michigan Health System, Ann Arbor. 3. Department of Biostatistics, School of Public Health, University of Michigan, Ann Arbor. 4. Research and Scientific Affairs, The Plastic Surgery Foundation, Arlington Heights, Illinois.
Abstract
Importance: Optimal treatment for traumatic digit amputation is unknown. Objective: To compare long-term patient-reported and functional outcomes between patients treated with revision amputation or replantation for digit amputations. Design, Setting, and Participants: Retrospective cohort study at 19 centers in the United States and Asia. Participants were 338 individuals 18 years or older with traumatic digit amputations with at least 1 year of follow-up after treatment. Participants were enrolled from August 1, 2016, to April 12, 2018. Exposures: Revision amputation or replantation of traumatic digit amputations. Main Outcomes and Measures: The primary outcome was the Michigan Hand Outcomes Questionnaire (MHQ) score. Secondary outcomes were the 36-Item Short Form Health Survey (SF-36), Disabilities of the Arm, Shoulder, and Hand (DASH), and Patient-Reported Outcomes Measurement Information System (PROMIS) upper-extremity module scores and functional outcomes. Results: Among 338 patients who met all inclusion criteria, the mean (SD) age was 48.3 (16.4) years, and 85.0% were male. Adjusted aggregate comparison of patient-reported outcomes (PROs) between patients with revision amputation and replantation revealed significantly better outcomes in the replantation cohort measured by the MHQ (5.93; 95% CI, 1.03-10.82; P = .02), DASH (-4.29; 95% CI, -8.45 to -0.12; P = .04), and PROMIS (3.44; 95% CI, 0.60 to 6.28; P = .02) scores. In subgroup analyses, DASH scores were significantly lower (6 vs 9, P = .05), indicating less disability and pain, and PROMIS scores higher (78 vs 75, P = .04) after replantation. Patients with 3 or more digits amputated (including thumb) had significantly better PROs after replantation than those managed with revision amputation (22 vs 42, P = .03 for DASH and 61 vs 36, P = .01 for PROMIS). Patients who underwent replantation after 3 or more digits amputated (excluding thumb) had higher MHQ scores, which did not reach statistical significance (69 vs 65, P = .06). Revision amputation in the subgroup with single-finger amputation distal to the proximal interphalangeal joint resulted in better 2-point discrimination (6 vs 8 mm, P = .05). Compared with revision amputation, replantation resulted in better 9-hole peg test times in the subgroup with 3 or more digits amputated (including thumb) (46 vs 81 seconds, P = .001), better Semmes-Weinstein monofilament test in the subgroup with 3 or more digits amputated (excluding thumb) (3 vs 21 g, P = .008), and better 3-point pinch test in the subgroup with 2 digits amputated (excluding thumb) (6.7 vs 5.6 kg, P = .03). Conclusions and Relevance: When technically feasible, replantation is recommended in 3 or more digits amputated and in single-finger amputation (excluding thumb) distal to the proximal interphalangeal joint because it achieved better PROs, with long-term functional benefit. Thumb replantation is still recommended for its integral role in opposition.
Importance: Optimal treatment for traumatic digit amputation is unknown. Objective: To compare long-term patient-reported and functional outcomes between patients treated with revision amputation or replantation for digit amputations. Design, Setting, and Participants: Retrospective cohort study at 19 centers in the United States and Asia. Participants were 338 individuals 18 years or older with traumatic digit amputations with at least 1 year of follow-up after treatment. Participants were enrolled from August 1, 2016, to April 12, 2018. Exposures: Revision amputation or replantation of traumatic digit amputations. Main Outcomes and Measures: The primary outcome was the Michigan Hand Outcomes Questionnaire (MHQ) score. Secondary outcomes were the 36-Item Short Form Health Survey (SF-36), Disabilities of the Arm, Shoulder, and Hand (DASH), and Patient-Reported Outcomes Measurement Information System (PROMIS) upper-extremity module scores and functional outcomes. Results: Among 338 patients who met all inclusion criteria, the mean (SD) age was 48.3 (16.4) years, and 85.0% were male. Adjusted aggregate comparison of patient-reported outcomes (PROs) between patients with revision amputation and replantation revealed significantly better outcomes in the replantation cohort measured by the MHQ (5.93; 95% CI, 1.03-10.82; P = .02), DASH (-4.29; 95% CI, -8.45 to -0.12; P = .04), and PROMIS (3.44; 95% CI, 0.60 to 6.28; P = .02) scores. In subgroup analyses, DASH scores were significantly lower (6 vs 9, P = .05), indicating less disability and pain, and PROMIS scores higher (78 vs 75, P = .04) after replantation. Patients with 3 or more digits amputated (including thumb) had significantly better PROs after replantation than those managed with revision amputation (22 vs 42, P = .03 for DASH and 61 vs 36, P = .01 for PROMIS). Patients who underwent replantation after 3 or more digits amputated (excluding thumb) had higher MHQ scores, which did not reach statistical significance (69 vs 65, P = .06). Revision amputation in the subgroup with single-finger amputation distal to the proximal interphalangeal joint resulted in better 2-point discrimination (6 vs 8 mm, P = .05). Compared with revision amputation, replantation resulted in better 9-hole peg test times in the subgroup with 3 or more digits amputated (including thumb) (46 vs 81 seconds, P = .001), better Semmes-Weinstein monofilament test in the subgroup with 3 or more digits amputated (excluding thumb) (3 vs 21 g, P = .008), and better 3-point pinch test in the subgroup with 2 digits amputated (excluding thumb) (6.7 vs 5.6 kg, P = .03). Conclusions and Relevance: When technically feasible, replantation is recommended in 3 or more digits amputated and in single-finger amputation (excluding thumb) distal to the proximal interphalangeal joint because it achieved better PROs, with long-term functional benefit. Thumb replantation is still recommended for its integral role in opposition.
Authors: Christopher Stephen Crowe; Benjamin Ballard Massenburg; Shane Douglas Morrison; James Chang; Jeffrey Barton Friedrich; Gdiom Gebreheat Abady; Fares Alahdab; Vahid Alipour; Jalal Arabloo; Malke Asaad; Maciej Banach; Ali Bijani; Antonio Maria Borzì; Nikolay Ivanovich Briko; Chris D Castle; Daniel Youngwhan Cho; Michael T Chung; Ahmad Daryani; Gebre Teklemariam Demoz; Zachary V Dingels; Hoa Thi Do; Florian Fischer; Jack T Fox; Takeshi Fukumoto; Abadi Kahsu Gebre; Berhe Gebremichael; Juanita A Haagsma; Arvin Haj-Mirzaian; Demelash Woldeyohannes Handiso; Simon I Hay; Chi Linh Hoang; Seyed Sina Naghibi Irvani; Jacek Jerzy Jozwiak; Rohollah Kalhor; Amir Kasaeian; Yousef Saleh Khader; Rovshan Khalilov; Ejaz Ahmad Khan; Roba Khundkar; Sezer Kisa; Adnan Kisa; Zichen Liu; Marek Majdan; Navid Manafi; Ali Manafi; Ana-Laura Manda; Tuomo J Meretoja; Ted R Miller; Abdollah Mohammadian-Hafshejani; Reza Mohammadpourhodki; Mohammad A Mohseni Bandpei; Ali H Mokdad; Mukhammad David Naimzada; Duduzile Edith Ndwandwe; Cuong Tat Nguyen; Huong Lan Thi Nguyen; Andrew T Olagunju; Tinuke O Olagunju; Hai Quang Pham; Dimas Ria Angga Pribadi; Navid Rabiee; Kiana Ramezanzadeh; Kavitha Ranganathan; Nicholas L S Roberts; Leonardo Roever; Saeed Safari; Abdallah M Samy; Lidia Sanchez Riera; Saeed Shahabi; Catalin-Gabriel Smarandache; Dillon O Sylte; Berhe Etsay Tesfay; Bach Xuan Tran; Irfan Ullah; Parviz Vahedi; Amir Vahedian-Azimi; Theo Vos; Dawit Habte Woldeyes; Adam Belay Wondmieneh; Zhi-Jiang Zhang; Spencer L James Journal: Inj Prev Date: 2020-03-13 Impact factor: 2.399
Authors: Ravindra Bharathi; Praveen Bhardwaj; Vigneswaran Varadharajan; Hari Venkatramani; S Raja Sabapathy Journal: Indian J Plast Surg Date: 2021-03-04