Abstract
Introduction: Amputation of digits/thumb is quite common in industrial areas of Karachi. Loss of digits/ thumb can lead to physical and functional disability and subsequent loss of job of a worker. Amputated digits/ thumbs can be re-implanted with adequate functional outcome provided microsurgical expertise, are available.
Materials and Method: A retrospective study was done to determine the outcome of reimplanted digits/thumb performed at AKUH from 1997 to 1999. All the patients with primary reimplantation of digits/thumb were include in the study while patients with primary stump formation, were excluded. The data was collected through a questionnaire after reviewing clinical records of patients. The important variables being demographic data, mechanism of injury, type of amputation, duration of amputation, digit involved and site of amputation, procedure performed (reimplantation / revascularization) complication, revision surgery, follow up and outcome. The functional outcome was measured using Chen’s criteria. The analysis was done using EPI info statistical package.
Results: Reimplantation was performed in 20 patients and revascularization was done in 4 patient from 1997 to 1999. The age ranged from _ year to 55 year with average age of 20 years. There were 22 male and 2 female patients. There were 8 cases of thumb, 14 cases of digits (index finger5, middle finger 4, ring finger 3 and little finger 2) and 2 cases of toe reimplantation.
The mechanism of amputation was industrial accidents in 18 cases and domestic injuries in 6 cases. The various types of amputations were a avulsion type in 3 cases, guillotine in 7 and amputation with localized crush in 14 cases. These patients presented to us with average duration of 7 hours after injury ranging from 4–10 hours. Ten cases were operated under L/A and 14 cases under G/A. Four of 24 cases required revision surgery due to venous block. The average follow up was 16 months ranging from 3 months–3 years.
The results were graded according to Chen’s criteria. Four cases had grade I, 9 had grade II and 1 grade III functional outcome according to Chen’s criteria.
Discussion: Although reimplantation of digits/thumb is successful procedure with refined microsurgical techniques. These procedures are long, tedious and demanding. Patient with re-implanted digits return to their job early but still have few complications like fingertip atrophy and diminished two point discrimination. Benefits and draw backs of reimplantation should be weighed before under taking reimplantation procedure.
The abstracts were prepared by Professor Jegan Krishnan. Correspondence should be addressed to him at the Flinders Medical Centre, Bedford Park 5047, Australia.
