Analysis of Outcomes of Tamai Zone I Digital Replantation in Cases of Severe Crushing Injury

Abstract

Purpose: Digital replantation has dramatically changed the fate of mutilated injuries of hand. But in case of severe crushing injury in Tamai zone I, it is a contraindication of replantation. This study aims to determine the replantation survival rate in cases with crushing injury.Methods: We retrospectively evaluated patients’ charts and photos from January 2015 to December 2019. There were 294 patients (331 fingers) with digital amputation who underwent surgery. Cases with crushing were divided into petechiae-in-skin group and red-line-sign group and compared with the group without crushing. The relationship of survival rate with factors was evaluated using chi-square analysis.Results: Of these, 199 fingers were defined as severe crushed, and 140 cases with petechiae in skin and 59 cases with red line sign. There was no statistically significant difference in survival rate compared with the group without crushing (p=0.227). Additional surgery was performed more in crushed injury. However, necrotized soft tissue was mainly on margin of amputation, not on crushed area.Conclusion: The presence of crushing did not affect survival rate in Tamai zone I replantation. However, as the degree of crushing was severe, the need for additional surgery increased. We found that the number of anastomosed arteries and veins influences the survival rate. According to our analysis, even if it’s difficult, finding and doing anastomosis as many vessels as possible can make good results.