| Objective:The aims of this study were(1)to conduct a clinical study of fingertip revision amputation and fingertip replantation to compare the outcomes of two treatments on fingertip amputation injuries to provide best evidence of functional outcomes;(2))to perform a systematic review of English studies to provide better evidence for fingertip revision amputation and fingertip replantation in clinical study;(3)to do a survey to abtain the attitudes regarding fingertip amputation treatment to help surgeon to make a recommendationMethods1.We collected fingertip amputation patient data from March 2013 to June 2014.One hundred and eight patients were included in our study.Patients should have fingertip amputation injuries from the distal interphalangeal joint.Two groups were divided according to the different treatment methods,which are replantation group(50 patients)and revision amputation group(58 patients).Replantation patients were performed fingertip replantation under general anesthesia.Fingertip revision amputation patients were performed local flap to cover the defect.The OR time and complications and expense in hospital were analized between the two group.Postoperatively,two-point discrimination,arc of motion of DIP joint and PIP joint,Visull Analog Scalc,Tinel sign,satisfaction were recoreded.2.A MEDLINE literature search was performed to identify studies that met the following criteria:(1)Reported primary data;(2)Included at least 5 cases of primary revision amputation treatment following digit amputation injury;(3)Reported finger or thumb amputation at or distal to the distal interphalangeal(DIP)joint or interphalangeal(IP)joint,respectively;(4)Presented at least one of the following outcomes:static two-point discrimination(2PD),cold intolerance,arc of motion(AOM)of metacarpophalangeal(MCP)joints,proximal interphalangeal joints(PIP),DIP joints,or return to work-time.3.Based on the conclusion of the first part,we developed a questionnaire and did a survey on 428 people,and assess the preference of the treatment choice for different people related to fingertip amputation.Results1.The successful rate of fingertip replantation is 86%,and 98%for fingertip revision amputation treatment.The complication rate of were 16%for fingertip replantation,and 2%for fingertip revision amputation.The in-hospital time for fingertip replantation is 5 days,and one day for fingertip revision amputation.The total expense on finger replantation is around 30527Y,fingertip revision amputation treatment is 3145 Y.The OR time is 4±0.4 hours,and 1±0.2 hours for fingertip amputation revision treatment.The return to work time for fingertip replantation is 8.9±0.9 weeks and 5.5±0.7 weeks for fingertip revision amputation.There were no significant demographic differences between the two groups,as well as the surface of the injuries(P>0.05).The 2PD,Arc of motion of DIP/PIP joint was 8.9±0.9 w、5.0±1.5 mm、68.5±7.9°和 89.5±4.6° in the replantation group,respectively.In the revision amputation group the 2PD was 5.3±2.1 mm,the DIP/PIP joint was 66.1±6.7°,90.4±5.0°.The revision group has shorter healing time than the replantation group(P<0.05).The VAS no pain,slightly pain and moderate pain was in 22(44.0%),20(40.0%)and 8 patients(16.0%),respectively in replantation group.VAS no pain,slightly pain and moderate pain was in 25(43.1%),25(43.1%)and 8(13.8%)in revision amputation group,(P>0.05);Posteoperatively,the satisfaction rates have no difference between the two groups.(P>0.05);2.Thirty-eight studies met the inclusion criteria.Twenty-seven studies reported 2PD,20 studies reported cold intolerance,8 studies reported AOM,and 18 studies reported return to work time after revision amputation of fingertip injuries.The mean 2PD was 5.6mm.On average,24%of patients experienced cold intolerance.AOM at the PIP joint was reported in 4 studies and averaged 94°.DIP joint AOM was presented in 4 studies and averaged 66°.Thumb MCP and IP joint AOM was presented in three and four studies,respectively.Mean thumb MCP joint AOM was 54° and that of the IP joint was 71°.The mean return to work time was 47 days.3.Four hundred twenty-eight questionaires were obtained,83%chosed fingtip replantation,and 17%chosed revision amputation.Once being educated about the shorcomes of the treatments,47%chosed revision ampuatition among people younger than 30 years old.38%people older than 50 years chosed revision amputation.Conclusion:We synthesizes the evidence on revision amputation and replantation for fingertip amputation injury.The results can aid surgeons and patients when making decisions regarding fingertip replantation and fingertip revision amputation.After fingertip revision amputation,we recommend fingertip revision amputation treatment for people who ask for short time recover.For patients who need adequate aesthetic outcomes,physicians should discuss with patients to make a correct decision. |
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