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Replantation of digit-tip amputation caused by crush injuries with supermicrosurgery technique

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European Journal of Trauma and Emergency Surgery Aims and scope Submit manuscript

Abstract

Purpose

Digit-tip amputation caused by crush injury is a common emergency scenario, and the management is full of challenges. The objective of this study was to demonstrate the application of the supermicrosurgery technique in replantation procedures for complex digit-tip amputations resulting from crush injuries, while also assessing functional and aesthetic outcomes.

Methods

We conducted a retrospective analysis of the data from 12 patients who underwent replantation of 15 digits in our department between July 2022 and June 2023. The outcomes of replantation, functional recovery (including return to work, cold tolerance, bone union, DASH score, VAS score, and two-point discrimination test), aesthetic results (including digit appearance, nail deformity, and pulp atrophy), and patient satisfaction were assessed.

Results

The amputation of 7 digits occurred within Tamai zone I level, 8 digits within Tamai zone II level, while 4 digits occurred within Ishikawa zone I level, 3 digits within Ishikawa zone II level, 7 digits within Ishikawa zone III level, and 1 digit within Ishikawa zone IV level. The replanted digits all survived (100%) without any indications of arterial insufficiency or venous congestion. The follow-up procedures were conducted on all 12 patients, with an average duration of 9.6 months (range, 6 to 18 months). The fracture successfully underwent healing at 9.2 weeks (range, 8 to 13 weeks). The mean VAS score was 1.75 points (range 0 to 4 points), the mean two-point discrimination test result was 5.72 mm (range 4.0 to 7.0 mm), and the mean DASH score was 9.78 points (range 3.33 to 22.5 points). All patients demonstrated cold tolerance and successfully resumed their pre-injury occupational activities. The nail deformity was observed in one digit following replantation within Tamai zone I, and in three digits following replantation within Tamai zone II; moreover, eight digits exhibited varying degrees of pulp atrophy. All patients expressed satisfaction with both functional and aesthetic outcomes.

Conclusion

The successful replantation of digit-tip amputation caused by crush injury can be achieved through the application of supermicrosurgery technique, resulting in improved functional and aesthetic outcomes. Digit-tip replantation is a favorable and meaningful procedure with high patient satisfaction.

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Data availability

No datasets were generated or analysed during the current study.

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Funding

This study was supported by the Natural Science Foundation of Hunan (2023JJ40901).

Author information

Authors and Affiliations

  1. Department of Orthopedics, The Third **angya Hospital, Central South University, No. 138, Tongzipo Road, Changsha, 410013, Hunan, People’s Republic of China

    ** Peng, Qiang Guo, Yifu Tang, Yuzhao Huang & Ling Luo

  2. Department of Orthopedics, The Second **angya Hospital, Central South University, No. 139 Renmin Road, Changsha, 410011, Hunan, People’s Republic of China

    Jianwei Wei

  3. Department of Orthopedics, Henan Provincial People’s Hospital, Zhengzhou, 450003, Henan, People’s Republic of China

    Lei Zheng

Authors
  1. ** Peng
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  2. Qiang Guo
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  4. Yuzhao Huang
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  5. Ling Luo
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Contributions

PP and LL designed the research and drafted the manuscript. QG and YFT performed the surgical treatment, participated in its design and coordination, and helped to write the manuscript. YZH, JWW and LZ helped to collected and analyzed the patient data. All authors had read and approved the final manuscript and ensured that this is the case.

Corresponding author

Correspondence to Ling Luo.

Ethics declarations

Ethics approval

This study was approved by the medical ethics committee of the Third **angya Hospital Central South University. All patients involved in this study gave informed written consent to participate.

Consent for publication

Written informed consent was obtained from all participants.

Competing interests

The authors declare no competing interests.

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Peng, P., Guo, Q., Tang, Y. et al. Replantation of digit-tip amputation caused by crush injuries with supermicrosurgery technique. Eur J Trauma Emerg Surg (2024). https://doi.org/10.1007/s00068-024-02485-z

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