Finger Replantation: Indications and Outcomes

Very few cases cause such a visceral reaction in the hand or microsurgeon as a replantation. Since the first successful digital replantation in 1965, we have had nearly 60 years to reflect and learn from our experiences. Arguably, the most critical things we have come to understand are the indications, contraindications, and expected outcomes in this patient population. Specific indications are deemed absolute in nature. In almost all cases, the amputation of a thumb, the amputation of multiple digits, and an amputation in a child are all microsurgical emergencies that should proceed with an attempt at replantation. Relatively indicated injuries are those occurring in zone I and those based on patient wishes, which are often based on cultural or religious beliefs. Relative contraindications include zone II injuries (single digit), patient co-morbidities such as peripheral vascular disease or diabetes, smoking, and socioeconomic factors. Absolute contraindications typically revolve around the condition of the amputated part, the donor site, and the medical status of the patient. Should the procedure pose a threat to the patient’s survival, replantation should not proceed. Certain factors predict success, such as the type of injury and optimal surgical and post-surgical management. That said, success defined as digital viability is not the same as success defined as a functional digit. The results of replantation, though thought to be better than revision amputation, are certainly not as good as they can be. As we refine our indications and techniques, we can continue to improve outcomes in the future.