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How Far Would You Go To Keep a Fingertip: Public Opinion on Distal Digital Replantation
Ledibabari M Ngaage, MA Cantab, MB BChir
1,2, Ritu Agarwal, BS
2, Aviram M. Giladi, MD, MS
2; Valeriy Shubinets, MD
3(1)Johns Hopkins University School of Medicine, Baltimore, MD, (2)The Curtis National Hand Center, Baltimore, MD, (3)Plastic Surgery, The Curtis National Hand Center, Baltimore, MD
Introduction: The goal of this study was to better understand public perception of distal digital replantation. When facing a choice of fingertip replantation versus an amputation, we hypothesized that the public would generally prefer replantation, but their enthusiasm may decline when additional clinical factors associated with replantation are presented to them.
Materials & Methods: A 9-item survey instrument was administered to participants via Amazon Mechanical Turk (MTurk). The data were collected through Qualtrics. After describing a scenario where the tip of the non-dominant middle finger was amputated at the distal interphalangeal joint, the survey first asked the participants if they preferred replantation or amputation of the severed fingertip. The survey then introduced additional context associated with replantation: (1) need for 4-hour surgery and general anesthesia, (2) extended hospital admission, (3) possible blood transfusions, (4) longer time until return to work, and (5) potential risk of delayed revision amputation of replanted digit. The relative importance of each clinical circumstance was assessed. The participants were also asked to reflect on which aspect of missing their fingertip would be most bothersome to them, and which digit they considered most important besides thumb. Categorical data were summarized using percentages. The chi-squared test and Fisher exact test were used to test for differences between categorical data, as appropriate.
Results: 211 respondents completed the questionnaire. When offered no additional clinical context, 86% of respondents chose replantation of the distal fingertip versus amputation. However, this number decreased when respondents were told replantation requires: a 4-hour surgery and general anesthesia (77%), extended hospital admission (74%), possible blood transfusion (73%), delay in return to work (72%), and possibility of delayed revision amputation of replanted digit (72%). Four-hour surgery with general anesthesia was identified as the most concerning factor and extended hospital admission was identified as the least concerning factor. "Loss of finger length" was identified as the most devastating factor whereas "losing the ability to go to work" was identified as least devastating. Of non-thumb digits, respondents ranked the index finger as the most important.
Conclusion: The majority of respondents demonstrate a preference for distal fingertip replantation rather than an amputation. While additional clinical context significantly decreased the enthusiasm for replantation, most respondents still chose replantation. The results of this survey shed light on public perception of replantation and which factors matter most, potentially enhancing shared decision-making between the surgeon and the patient.
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