Sensory recovery following digital replantation

The recovery of sensibility following digital replantation is essential in the restoration of hand function. We reviewed 12 series of digital replantations between 1977 and 1989. Three hundred sixty-seven fingers and 87 thumbs were successfully replanted. Mean age was 32.5 years. Mean follow-up was 33.5 months. Mean static two-point discrimination (S2PD) was 9.3 mm in clean thumbs vs. 12.1 mm in crush/avulsion thumb replantations. Mean S2PD was 8 mm in clean finger vs. 15 mm in crush/avulsion finger replantations. Overall mean S2PD was 11 mm in thumb and 12 mm in finger replantations. Sixty-one percent of replanted thumbs and 54% of replanted fingers regained useful S2PD (less than 15 mm or greater than or equal to S3 +). Factors that influenced digital sensibility following replantation included patient's age, level and mechanism of injury, digital blood flow, cold intolerance, and postoperative sensory reeducation. Recovery of sensibility in the replanted digit is comparable to simple nerve repair and to nerve grafting techniques. Further emphasis should be on elucidating the mechanism of cold intolerance, which was a significant complaint for most replanted digits. The universal practice of postoperative sensory reeducation will continue to improve digital sensibility following replantation.