Microsurgical Digits Replantation in Resource-Limited Setting: A Retrospective Study

Abstract

Background

This article aims to share our experiences with microsurgical finger replantation in a resource-limited setting.

Methods

This multi-institutional, retrospective study included 21 cases of finger amputation that underwent microsurgical replantation, within 7 years period. Patient demographics, preoperative assessments, surgical approaches, and outcomes were documented and analyzed. A univariate analysis was performed to obtain factors associated with digit reimplantation failure.

Results

Out of 21 cases included, 8 (38.1%) had complete amputations and 13 (61.9%) had incomplete amputations. Crush injuries accounted for the majority (71.4%). On average, 2.2 ± 1.1 digits were affected, with the ring finger being the most commonly injured (71.4%). The mean operative time was 121.5 ± 26.8 minutes. The success rate of digit replantation was 76.2%. During a mean follow-up of 14.3 ± 3.7 months, 85.7% of successfully replanted digits considered their replantation results satisfactory. The majority of replanted digits demonstrated active and effective holding and grasping abilities without pain or instability (76.2%). Replantation failure was associated with a higher number of affected digits (p < 0.001), longer operative time (p = 0.004), complete avulsion (p = 0.003), current smoking (p = 0.025), diabetes (p = 0.006), hypertension (p = 0.047), procedure difficulty score (p= 0.004), and occurrence of complications (p < 0.001).

Conclusion

Microsurgical finger replantation can yield favorable outcomes and acceptable survival rates, even within resource-limited settings. However, this procedure requires specialized equipment and personnel that may not be available at all institutions. Influential factors in digit replantation failure, include an increased number of damaged digits, extended operative duration, complete avulsion, current smoking, diabetes, hypertension, procedure difficulty score, and postoperative complications occurrence.

Keywords:

• microsurgery
• digital replantation
• amputation
• resource-limited setting

Data Sharing Statement

All the data was included in this study.

Ethics Approval and Informed Consent

The college’s research review and ethical committee of 21 September University for Medical and Applied Sciences, Sana’a, Yemen approved this project on 16, Jun 2022 with ID number: H-09-E-16-A10, which was carried out in accordance with the Declaration of Helsinki. Written informed consent was obtained from the patients.

Consent for Publication

Written informed consent was obtained from the patients including the figures. Parent or legal guardian of patients under 18 years of age provided informed consent for participation and publication of the case details and images.

Disclosure

The authors report no conflicts of interest in this work.

Additional information

Funding

There is no funding to report.