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Functional Outcomes in Single Digit Zone II Amputations Treated With Replantation vs Revision Amputation: A Comparative Retrospective Study
Mostafa El-Diwany, BSc1; Milène Bélanger-Douet, BSc1; Andrei Odobescu, MD, CM2; Marie-Pascale Tremblay-C, MD1; Djamal Berbiche1; Josée Arsenault, BSc, MSc1; Joseph Bou-Merhi, MD, FRCSC2; Patrick G. Harris, MD, CM2; Michel Alain Danino, MD, PhD3
1University of Montreal Health Centre (CHUM) - Notre Dame Hospital, Montreal, Canada; 2University of Montreal, Montreal, Canada; 3Montreal University Hospital, Montreal, Canada

Introduction: Replantation of single zone II amputated digits is cited by some as a relative contraindication due to poor functional outcomes. Nevertheless, some surgeons at our institution offer patients the choice of undergoing such a procedure. The objective of this study was to compare the functional outcomes of zone II amputations treated with either replantation or revision amputation in our institution.
Methods: We conducted a comparative retrospective study. All cases of single digit amputations received at Québec's Replantation Center between 2007 and 2011 were screened for single digit zone II injuries. These patients were stratified based on the treatment received: replantation vs revision amputation. Patients were called and invited to participate in the research project. Those who accepted to enter the study were asked to complete the Quick-DASH, the Beck, and a homemade questionnaire. All participants were offered a medical consultation for reevaluation at our center.
Results: Seventeen patients with single digit zone II replantations and 14 patients with similar injuries who underwent revision amputation agreed to take part in the study. Our data revealed that time to return to work, occupation after injury, professional and social reintegration, discontinued activities, and self-confidence were not statistically different between the two groups. Average hospital stay of replanted individuals was longer at 5.5 days vs 0.36 days (p = 0.0001). Similarly, the follow up period of these patients was also longer (25.5 vs 5.8 weeks). Furthermore, patients who underwent replantation did not have higher levels of pain or cold intolerance and the global functional and aesthetic satisfaction levels were similar between the two groups. Also, Beck and Quick-DASH scores were not statistically different. Yet, the replantation group had a significantly higher adherence rate to the same surgery (94% ; 64%).
Conclusions: Our center's experience with single digit zone II replantations suggests that the functional outcomes expected are not worse than those obtained with revision amputation. We therefore recommend replantation of zone II amputated digits, as long as the patient desires replantation.


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