Sequential Clinical Recovery after Replantation for Complete Finger Amputation in Tamai Zone 1

Area of Science:

• Hand surgery
• Microsurgery
• Orthopedic surgery

Background:

• Distal finger replantation outcomes are generally acceptable.
• Limited data exists on the sequential recovery patterns post-replantation.
• Understanding long-term functional recovery is crucial for patient management.

Purpose of the Study:

• To evaluate the sequential clinical recovery of completely amputated distal fingers up to one year post-replantation.
• To track functional outcomes including range of motion, strength, sensation, and patient-reported disability.
• To identify factors influencing recovery and potential complications.

Main Methods:

• A prospective study of 19 patients with complete distal finger amputations (Tamai zone 1) who underwent successful replantation.
• Assessment of total active motion (TAM), grip strength (GS), Semmes-Weinstein (SW) monofilament test, static two-point discrimination (s2PD), and Disability of the Arm, Shoulder, and Hand (DASH) scores at 3, 6, 9, and 12 months.
• Evaluation of pulp atrophy and nail deformity at 12 months.

Main Results:

• Significant improvements in %TAM, %GS, s2PD, and DASH scores were observed between 3 and 6 months postoperatively.
• %TAM and %GS showed significant recovery from 3 to 6 months (p < 0.01 and p = 0.02, respectively).
• Sensation (SW test) improved significantly between 3 and 12 months (p = 0.04). DASH scores at 12 months correlated with %TAM (r=-0.64), %GS (r=-0.58), and age (r=0.52).

Conclusions:

• Distal finger replantation demonstrates significant functional recovery within the first six months postoperatively.
• While initial recovery is rapid, functional gains plateau between 6 and 12 months.
• Potential complications include pulp atrophy and nail deformity, highlighting the need for continued monitoring.