Long-term clinical results of 33 thumb replantations. (December 2020) - Giardi, Davide
Highlights: Studied a cohort of patients who underwent a reconstructive procedure after complete amputation of thumb. We evaluated cold intolerance, neuropathic pain and augmented time of capillary refill, thumb sensibility, and overall upper limb function. Outcomes of force peak tests, Kapandji tests and DASH tests were comparable to healthy subjects in more than 50% of patients. Semmes-Weinstein tests showed the recovery of the great majority of patients (73%) recovered the protective sensation, 2-points discrimination was recovered in 54% of patients (S2PD test), and in 39% of patients (M2PD test). Abstract: Introduction: Thumb replantation following complete amputation is a relatively frequent and well-established surgical procedure. In literature many studies report a discrepancy between the objective measurements and the subjective satisfaction of the patients. Nowadays, evaluation of the patient long-term benefit obtained by replantation is uncertain. The aim of this study was to consider the long-term results of 33 thumb replantation procedures. Methods: The period considered is from January 1997 to December 2015, 33 subjects fulfilled the study inclusion criteria and were included in the study. We evaluated in each patient: ROM (performing Kapandji test), level and mechanism of amputation, force peak of three grips using Dexter dynamometer (five-handle, key, tri-digital grips), sensibility (using Disk-Criminator and aesthesiometers of Semmes-Weinstein) and subjective perception of disability (using DASH questionnaire). Results: All patients were males, 94% of them returned to their previous occupation. Average follow-up was 9±4 years. The prevalent mechanism of injury was a combined amputation in 58% of cases. Levels involved in more than half of patients were interphalangeal joints and proximal phalanxes. Ratios of strength recovery were: for the five-handle grip equal to 0.90±0.28 kg ( p =0.63), 0.78±0.30 kg ( p =0.64) for key grip and 0.75±0.32 kg ( p =0.78) for tri-digital grip. Results for Kapandji test was 8±2 and for DASH test was 16±21. The protective tactile threshold was recovered in 49% of patients; S2PD test resulted positive in 54% and D2PD test in 39% of cases. Conclusions: Results confirm and strengthen evidence of positive long-term functional outcomes of thumb replantation interventions.