Long-term functional, subjective and psychological results after single digit replantation

Abstract

Objective: The aim of this study was to analyse the long-term functional, subjective, and psychologicalresults after single-digit replantation.Methods: Thirty cases of digital replantation (14 thumbs, 12 indexŞngers, 2 middle Şngers, 1 ring Şnger,and 1 littleŞnger) in 30 patients (7 females and 23 males) with a mean age of 44.2 years (20e65 years)were evaluated at the end of a mean follow-up time of 36 months (19e50 months). The active range ofmotion of joints, grip and pinch strength, cutaneous sensibility, upper-extremity functioning, and subjective satisfaction were determined using the Disability of Arm, Shoulder, and Hand (DASH) questionnaire and the Michigan Hand Outcomes questionnaire (MHQ). Psychological sequelae, includingdepression, anxiety, and posttraumatic stress disorder (PTSD), were assessed. A correlation analysisamong variables was also performed.Results: The mean score for the DASH questionnaire was 6.6 (range: 0e39.2). The symptom of coldintolerance occurred in 53% of the patients. Two patients were diagnosed with depression, and only onepatient exhibited PTSD. The DASH score had a good statistical correlation with total grip strength, pinchgrip strength, and static two-point discrimination (S-2PD) (P< 0.05). Several aspects of the MHQ werealso statistically relevant to some or all of the three objective results. Furthermore, the grip strengthshowed signiŞcant correlation with DASH and most aspects of the MHQ in multivariate logisticregression analysis (P< 0.05).Conclusion: Total grip strength is the most important factor positively related to subjective outcomes.The incidence rates of psychological symptoms after digit replantation are very low at long-termfollow-up.Level of evidence: Level IV, therapeutic study.