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Selected Publication:
Bidassek, R.
The impact and long-time outcome of finger replantation
Humanmedizin; [ Diplomarbeit ] Medical University of Graz; 2015. pp. 111
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- Authors Med Uni Graz:
- Advisor:
- Kamolz Lars-Peter
- Prandl-Mira Eva-Christina
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- Abstract:
- Background: Several studies have reported on survival rates and the complications of finger replantation. To date, only few studies have approached return to work time and the subjective perception of patients treated. Therefore, we have chosen to conduct a study to evaluate the social and subjective consequences following finger replantation and to analyze return to work time and DASH score. Methods: 38 patients (4 women and 34 men) responded to questionnaires and formed the patient pool of this study. In addition to the DASH questionnaire a second questionnaire about return to work time and occupation change was created. HISS scores were also calculated. Tamai’s classification was used to collect data about the amputation level. The results were examined based on differences among the various patient groups. Furthermore, successful replanted patients have been compared with secondary stump treated ones regarding the return to work and change of occupation. Finally, correlation analyses between return to work time and DASH scores as well as HISS scores were performed. Results: Of 66 total replanted fingers, 57 fingers were replanted successfully (86.4%). Skilled agricultural and forestry workers as well as craft workers have a significantly higher severity of injury (p = 0.013) and significantly more often a finger amputation as a result of a work accident (p = 0.026) than other occupation groups. Comparing patients who underwent secondary stump treatment with those who had a successful replantation, no difference in subjective perception of ability occurred. A tendency to a longer return to work time was shown on the secondary stump treated patients. While 71.43% of the patients with successful thumb replantation could return to work and nobody had to change his/her occupation, the only patient with secondary stump treated thumb had to change it. Comparing thumb with long finger replantation, superior subjective perception of ability occurs in the case of long fingers, while a tendency to faster return to work time was found with thumb replantation. The time needed to return to work of long finger replanted patients depends significantly on the amputation level. Furthermore, the time to return to work after finger replantation is independent of changes or returns to previous occupations. Zone IV of Tamai’s amputation classification has a highly significant longer time to return to work towards patients with other zones (p = 0.007). Conclusion: Patients who work as skilled agricultural and forestry workers or as craft workers have a higher risk to contract a finger amputation at work. Despite of good outcomes, patients with these occupations tend to change their occupation more often than others. The amputated thumb as an absolute indication for finger replantation was confirmed because no single patient with stump treated thumb could return to work. The comparison between successfully replanted and secondary stump treated thumbs implies the importance of a successful thumb replantation. The highest rates for successful thumb replantation are exhibited in hand surgery centers only. Hence, to ensure the best possible outcome for finger replantation, patients with finger amputation should get transported directly to the nearest hand surgery center. Especially, amputated fingers in zone IV of Tamai’s classification need a longer time to return to work then amputations in other zones. This zone, which exists solely on long fingers turned out to be a “Zone of long return”.