Psychological outcomes following digital replantation and revascularization: A narrative review

Literature on digital replantation has historically prioritized primary outcomes such as viability rates, return-to-work timelines, and restoration of range of motion and grip strength. Psychological and psychosocial sequelae, including post-traumatic stress disorder (PTSD), depression, anxiety, sleep disturbance, adjustment disorder, and body image disruption, are reported inconsistently, infrequently, or not at all. This narrative review examines the scope and quality of psychological outcome reporting in the digital replantation and revascularization literature from 2015 to 2025.

A literature search of PubMed/MEDLINE, EMBASE, PsycINFO, CINAHL, Web of Science, and the Cochrane Library was conducted for English-language studies published between January 2015 and December 2025, using combinations of terms including "replantation," "revascularization", "digit amputation", "PTSD", "anxiety", "depression", "adjustment disorder", "body image", and "psychosocial outcomes". Studies reporting at least one psychological or psychiatric outcome following digital or upper extremity replantation, revascularization, or upper extremity amputation were included. Adult or mixed adult-pediatric cohorts were included. Given study heterogeneity, findings were synthesized narratively, to broadly characterize the available literature, by outcome domain.

Nineteen studies met inclusion criteria. Depression was the most frequently reported discrete outcome (10/19 studies, 52%), followed by anxiety (8/19 studies, 42%) and PTSD (7/19 studies, 36%). PTSD prevalence ranged from 46% to 69%, and depression and anxiety prevalence ranged from 7% to 71% across studies using validated instruments. Adjustment disorder was identified in two studies, including one large retrospective analysis (n = 1986) demonstrating significantly higher prevalence following replantation failure (2.7% vs <1%). Pre-injury anxiety was identified as an independent predictor of replantation failure in one prospective cohort. No included study reported formal psychiatric or behavioral health referral rates.

There is a pervasive gap in the reporting of psychological and psychosocial outcomes following digital replantation and revascularization. Existing evidence demonstrates that psychiatric morbidity is more common than is currently reflected in traditional surgical outcome reporting. Standardized, validated psychological screening instruments should be incorporated into replantation outcome reporting, and multidisciplinary care models inclusive of behavioral health are warranted.