Clinical outcomes of a simultaneous replantation technique for amputations of four or five digits.

Purpose: Replantation of amputations separated by more than four digits is challenging microsurgery because of the technical demands and long operation time. The purpose of this report was to present the clinical and functional outcomes in patients with amputations of four or five digits using a simultaneous replantation technique.

Patients And Methods: Among the 43 patients who visited our institution due to amputation of four or five digits from 2004 to 2013, 35 patients (28 males and seven females) underwent simultaneous replantation of four or five digits. The age range of the patients was 25-64 years (mean, 40.6 years). Simultaneous replantation technique included that bone was fixed and flexor tendons were repaired first and then digital vessels and nerves were simultaneously anastomosed for all amputated digits. The clinical and functional outcomes were evaluated at a minimum 1-year follow-up.

Results: Ischemic time was 150-510 min. Mean operation time was 313.2 min. In total, 127 of the 145 (87.5%) digits remained viable survived 2-weeks postoperatively, and four patients (16 digits) were lost to follow up. Of the 31 patients (129 digits), 19 (61.3%) had excellent and good outcomes using the criteria of Chen, and 21 patients (71%) were satisfied completely. Mean grip strength of the injured hand was 67% at the last follow-up.

Conclusion: The results from this series of cases showed that the simultaneous replantation technique for four or five digit amputations may provide an alternative method to shorten surgical time, reduce complication rates, and enhance high survival rate.