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American Association for Hand Surgery

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Psychosocial and Functional Impact of Digital Replantation
Peter L.C. DiGiovanni, BA1, Barbara Gomez, MD2, Yannick Albert J. Hoftiezer, MD1, Brigitte E.P.A. van der Heijden, MD, PhD3, Kyle R. Eberlin, MD4, Jonathan Lans, MD, PhD2 and Neal C. Chen, MD2, (1)Massachusetts General Hospital, Boston, MA, (2)Massachusetts General Hospital / Harvard Medical School, Boston, MA, (3)Radboud University Medical Center, Nijmegen, Netherlands, (4)Orthopaedic Hand and Upper Extremity Service, Massachusetts General Hospital, Massachusetts General Hospital / Harvard Medical School, Boston, MA

Introduction: The authors wanted to investigate the long-term psychosocial and functional scores in patients who underwent successful replantation of traumatically amputated fingers.

Materials and Methods: A total of 168 patients treated by replantation of at least one amputated digit between January 2009 and April 2019 were identified by using CPT and ICD-9/10 codes. Patients were invited by mail and phone to complete questionnaires regarding their psychosocial well-being and their perceived functional status. In total, 36 patients were successfully enrolled and their medical charts were manually reviewed to collect further data. Outcomes included Patient Reported Outcomes Measurement Information System (PROMIS) scores for Global Health, Upper Extremity Function, and Depression. Additionally, patients were asked to rate the effect the injury and subsequent replantation had on their personal salary, household income, and mental well-being using a VAS scale.

Results: The median duration of follow-up was 6.10 years (IQR 3.24 - 9.10) and 94.4% of patients were male. Most common were replantations of a single digit, which occurred
in 61.1% of patients. The median PROMIS score for Upper Extremity Function (40.6, IQR 35.7 -
48.0) differed from the score of 50 (standard deviation 10) found in the general population, but
the median PROMIS scores for Global Health Physical (49, IQR 44.3 - 52), Global Health Mental
(50.7, IQR 43.6 - 54.9) and Depression (45.6, IQR 38.8 - 48.8) were comparable to the general
population. While three patients had a definitive diagnosis of neuroma, seven patients (19.4%)
were currently on medication for neuropathic pain due to their injury. Dominant hand injury, number of injured digits, higher age at time of injury, and the need for neuropathic pain medication were associated with lower Upper Extremity Function scores (all p<0.05). Additionally, the presence of neuroma was associated with negative changes in both household finances (p=0.02) and mental well-being (p=0.04).

Conclusions:

  • The extent of injury, hand dominance, and patient age are associated with differences in long-term upper extremity function.
  • Additionally, neuropathic pain and the presence of neuroma were associated with worse upper extremity function scores, suggesting that improved prevention and treatment of these sequelae may benefit future patients.



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