A Geospatial Analysis of State-Level Access to Registered U.S. Replantation Centers

BACKGROUND: Following traumatic finger amputation, successful replantation depends on several preoperative factors, with proximity to a registered hand trauma center being a key determinant. These centers represent the standard for treatment, making timely access within a critical window essential. Research has demonstrated that increased travel distances and longer times to replantation correlate with poorer functional outcomes. METHODS: Using data from the American Society for Surgery of the Hand, the locations of registered hand trauma centers were mapped with advanced isochrone application programming interface modeling software, which uses complex algorithms to map and analyze areas reachable within specific time or distance thresholds. A shaded region was generated to indicate areas within a 6-hour and 12-hour travel radius of a registered hospital center. RESULTS: The District of Columbia (1.5), Oklahoma (0.98), and Minnesota (0.88) had the highest number of trauma centers per 1 million residents, whereas multiple states such as Nevada, Montana, and Kansas had 0 trauma centers. In terms of geospatial mapping, regions such as Houston, Texas; Indianapolis, Indiana; Columbus and Cincinnati, Ohio; and large cities in the Northeast such as New York, Philadelphia, the District of Columbia, and Boston, all have greater than 6 hand trauma centers. At a 6-hour catchment, 13.3% of the U.S. population lacks access to a registered hand trauma center; even when extended to 12 hours, 7.6% remain without coverage. CONCLUSIONS: Limited hospital and trauma center density remains a significant barrier to high-quality surgical care. Reducing travel times, increasing access in rural areas, and improving urban infrastructure could enhance replantation outcomes by ensuring that more patients reach registered hand trauma centers within the critical time window.