Outcomes Related to Mechanism of Zone I and II Finger Amputations Treated by Revision Amputation
Andrew Paul Harris, MD1; Andrew D Sobel, MD1; Avi D Goodman, MD2; Joseph A Gil, MD3; Neill Y Li, MD1; Jeremy Raducha, MD1; Julia A. Katarincic, MD4; (1)Brown University, Providence, RI, (2)Alpert Medical School of Brown University / Rhode Island Hospital, Providence, RI, (3)Orthopaedic Surgery, Warren Alpert School of Medicine, Brown University, Providence, RI, (4)Department of Orthopaedic Surgery, Brown University, Providence, RI
Revision amputation is the mainstay of treatment for non-replantable finger amputations. Though variable mechanisms of injury portend different results for replantation, no study has looked at the effect of mechanism on the success of revision amputation. Predicting the outcome of revision amputation based on mechanism of injury would allow for improved patient education and counseling and increased focus on prevention of secondary revision.
MaterialS AND METHOD
After IRB approval, our Level I trauma centerÕs emergency department database was retrospectively examined for patients presenting with flexor tendon zone 1 and 2 traumatic digit amputations from January 2010 to December 2015. Records were reviewed for the mechanism of the injury and parsed into one of eight categories. The causes for secondary revision after initial revision amputation were analyzed. All analyses were conducted using SAS Software 9.4 (SAS Inc. Cary, NC). In addition to standard descriptive statistics, conditional Cox Proportional Hazard regression with sandwich estimation, where digits were nested within patients, was used to model hazard of unplanned secondary revision censored at 1 year from index procedure relative to mechanism with PROC PHREG.
537 patients with 677 amputations were initially treated with primary revision amputation. Primary revision amputation was performed in the emergency department more commonly than in the operating room (481 vs. 56 patients). 74 patients with 83 amputation required unplanned secondary revision amputation within 1 year of index procedure. Relative to crush (TABLE 1), amputations caused by bites were 4.8-fold increased risk to require a secondary revision (p=0.0038) and those caused by lacerations were 2.6-fold increased risk(p=0.0108) (FIGURE 1). However, amputations caused by avulsion, lawnmower, saw, and snow blowers were not observed to be at higher risk for secondary revision (all p>.05). Exposed bone secondary to soft tissue necrosis and nail deformity were the most common complications requiring secondary revision.
¥ Bite and sharp laceration mechanisms causing digit amputations have an increased risk of unplanned secondary revision after primary revision amputation
¥ Revision amputations most commonly require secondary revision due to nail deformities and soft tissue necrosis
¥ Prevention of secondary revision should be focused on managing nailbed and germinal matrix injuries as well as adequately shortening bone and rearranging tissue to allow for appropriate coverage
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