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Management of the Amputated Finger: Revision Rates and Predictors of Success
Justine S. Kim MD, Shawn J. Loder MD, Elizabeth A. Moroni MD MHA, Alexander M. Spiess MD
University of Pittsburgh Medical Center
2020-02-14
Presenter: Justine Kim
Affidavit:
The majority of the work on this project represents the original work of the resident.
Director Name: Vu Nguyen
Author Category: Resident Plastic Surgery
Presentation Category: Clinical
Abstract Category: Hand
Background: Digit injuries represent a common trauma managed in the emergency setting with over 200,000 emergency department (ED) visits for finger amputation between 2002 and 2010. Appropriate initial management is critical to ensure the best functional outcome, recognizing that revision surgery is common. In this study, we identified characteristics of initial surgical triage associated with operative revision and/or more proximal phalangeal/joint resection.
Methods: This is a retrospective analysis of 177 amputated digits across 113 patients, managed by plastic surgery at our institution between 2010-2019. We assessed the mechanism, digit, anatomic level, intervention performed, post-operative course and follow-up. Patients were followed through their terminal clinic visits.
Results: 64 patients underwent immediate revision amputation in the ED for an average shortening of 0.46 anatomic levels. 24 patients (47 digits) progressed directly to the operating room (OR). 77 patients required at least one operative intervention with 28 requiring 2 or more trips to the OR. The most common indication for early revision was compromised soft tissue closure. Delayed revisions were secondary to pain/hypersensitivity (10.2%) or delayed graft/tissue necrosis (9.1%). On average, patients were revised 0.56 anatomic units by terminal intervention.
Conclusions: The most common indication for early operative revision was compromise of soft tissue closure. This correlated with need for either additional osseous resection and/or flap advancement/skin grafting in the OR. Reasons for compromise include exposure of the osseous stump and/or skin edge necrosis secondary to tight closure. These data suggest potential need for more aggressive initial osseous resection in the ED.
