Quantitative analysis of cold stress performance after digital replantation

Isolated cold stress testing (ICST) has been used to assess cold stress performance or digital thermoregulation, but statistical analysis of the results has been limited to visual comparisons of data. In this prospective study, 11 patients who underwent complete digital replantation were followed serially with ICST at 6 weeks, 3 months, 6 months, 1 year, and 2 years postoperatively, and the results were analyzed quantitatively. For that analysis, we devised a mathematical method that provided a cooling and a warming coefficient to fit the data. Differences in these cooling and warming coefficients were then regressed against time after replantation, patient age, number of digits replanted, hand dominance, and clinical evidence of sensory recovery. There was a significant correlation between response to isolated cold stress testing (thermoregulation) and degree of sensory recovery (p less than or equal to 0.02). This method for quantitative analysis of isolated cold stress testing data allows objective evaluation of digital blood flow patterns based on temperature, thereby providing a reliable and objective assessment of the recovery of thermoregulation in the replanted human digit.