Clinical outcomes and replant survival after microsurgical replantation following traumatic single-digit amputation

Vollständiger Abstract

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Aim Traumatic single-digit amputations may appear limited in extent, yet they can seriously impair hand function and quality of life. Factors determining survival of the replanted digit and functional recovery remain debated. We aimed to report our replantation outcomes and identify factors associated with replant survival. Methods Sixty patients who underwent microsurgical replantation for single-finger amputation between January 2020 and January 2025 were reviewed retrospectively. Patients were grouped according to injury mechanism (clean-cut, crush, or avulsion) and replantation outcome (success or failure). Demographic, clinical, and operative variables were evaluated together with survival, complications, range of motion, and time to return to work. Results Overall replant survival was 83.3%. Survival differed by injury mechanism: 90.0% after clean-cut injuries, 84.6% after crush injuries, and 42.9% after avulsion injuries (P = .012). Injury mechanism was the only variable significantly associated with replant survival; age, warm ischemia time, and smoking were not significant. Tendon adhesion was the most frequent complication (61.7%), whereas necrosis occurred in 16.7% of patients. Range of motion improved significantly from the first to the sixth postoperative month (P < .001). Mean time to return to work was 5.3 months. Conclusion Injury mechanism was the only variable significantly associated with replant survival in this cohort, with poorer outcomes after avulsion injuries. Tendon adhesion was the most common late complication, highlighting the importance of meticulous surgical technique and structured hand rehabilitation. In selected patients, microsurgical replantation remains a functionally valuable treatment option.