Flexor Tendon Continuity and Negative X-ray: The "Combo" Negative Features in Finger Subamputation

Area of Science:

• Microsurgery
• Hand Surgery
• Trauma Surgery

Background:

• Finger subamputations with vascular compromise pose significant surgical challenges.
• The correlation between soft tissue damage, radiographic findings, and outcomes in these injuries is not always direct.
• Assessing prognostic factors is crucial for successful surgical intervention.

Purpose of the Study:

• To evaluate the outcomes of microsurgical revascularisation for finger subamputations.
• To identify specific injury patterns associated with poor prognosis.
• To propose an update to the Kay-Adani Classification for subamputation injuries.

Main Methods:

• Retrospective analysis of 27 male patients undergoing microsurgical revascularisation for finger subamputations (May 2018 - July 2023).
• Inclusion criteria focused on vascular pedicle injury with attempted salvage; exclusion criteria included intact pedicles or immediate amputation.
• Specific attention was given to cases with only flexor digitorum profundus (FDP) or flexor pollicis longus (FPL) continuity.

Main Results:

• A global failure rate of 49% was observed for finger salvage.
• In cases with only FDP or FPL continuity (11 cases), the failure rate increased to 73%.
• Revascularisation failure reached 100% when flexor tendon integrity was present with minimal bone/articular damage.

Conclusions:

• Subamputations with devascularisation, characterized by sole flexor tendon continuity and minimal bone/articular injury, portend a worse prognosis.
• These findings suggest a need to refine existing classifications for subamputation injuries.
• The proposed addition to the Kay-Adani Classification (Group III) aims to aid surgical decision-making in complex cases.