Distal fingertip amputations are among the most common hand injuries, yet whether to replant or revise remains one of the most debated questions in hand surgery.

In this episode, we break down “A Systematic Review of the Outcomes of Replantation of Distal Digital Amputation” (Sebastin & Chung, PRS 2011). Thirty studies encompassing 2,273 distal replantations give us the best available evidence on survival, function, and complications. Contrary to the long-held belief that fingertip replants offer little value, this review shows high survival rates (86%) and meaningful functional recovery. We discuss survival differences by mechanism (clean-cut vs crush), the role of venous anastomosis, and long-term outcomes such as sensation, pulp atrophy, and nail deformity.

Key Takeaways:

• Survival: ~86% overall, similar between Zone I & II.

• Mechanism matters: Clean cuts survive better than crush/avulsion.

• Vein repair helps: Improves survival in both zones.

• Function: Mean 2-point discrimination 7 mm; most regain protective sensibility even without nerve repair.

• Work: 98% return to work reported.

• Complications: Nail deformity (~23%) and pulp atrophy (~14%) remain common.

  
  

This paper challenges the myth that distal replants are “not worth it” — showing reproducible, good outcomes when performed by skilled microsurgeons.

References:

Sebastin SJ, Chung KC. A systematic review of the outcomes of replantation of distal digital amputation. Plast Reconstr Surg. 2011;128(3):723–737. doi:10.1097/PRS.0b013e318221dc83

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