CURRENT INDICATIONS FOR SINGLE DIGIT REPLANTATION

The functional outcome of 67 successfully replanted single digits (exc luding the thumb) involving 31 complete and 36 incomplete nonviable am putations was found to be strictly related to the level of the amputat ion. While the survival rate was higher in patients with incomplete no nviable amputations (89 percent), compared to those with complete ampu tations (81 percent), the ability of the patient to use their digit wa s almost uniform among both groups of patients. All except 2 of the 9 digits with complete amputations at the level of the proximal phalanx or at the proximal interphalangeal joint (PIP) resulted in limited mot ion (less than 20 degrees-30 degrees) at the PIP and distal interphala ngeal (DIP) joints. Only 9 from the group of patients with incomplete nonviable amputations at the proximal phalanx exceeded flexion greater than 40 degrees at the PIP joint. From these results, we conclude tha t the indications for replantation of a single digit amputation should be as follows: 1) amputation distal to the insertion of the flexor di gitorum sublimis; 2) ring injuries type II and IIIa; and 3) amputation s at the level of or distal to the DIP joint.