Replanted Amputated Digit Survival and Associated Factors at a Tertiary Center in Southern Thailand: A Multi-Level Analysis

Background: Traumatic digital amputations require early replantation, and proper surgical technique is a critical factor for a successful digital replantation. Non-surgical factors can also effect the digital survival rate. Previous studies have used univariate analysis and logistic regression which could not identify the various complex associations of patient-related and digit-related factors. This study aimed to identify the determinants of digital survival after replantation, using multi-level analysis.

Methods: A retrospective analysis of 209 patients with 272 finger revascularizations and replantations performed from the metacarpophalangeal joint to the end of the finger. Demographic data, place of injury, mechanism of injury, level of amputation, and success rate were examined.

Results: The overall survival rate of digital replantation during the study period January 2004–December 2017 was 64%. Surgeon’s experience 3–5 years (OR 13.04), type of injury as guillotine (OR 6.79) and number of venous anastomoses for two veins (OR 6.83) were the most important pre-operative and intra-operative factors affecting the survival rate as clarified by a multi-level hierarchical model.

Conclusions: Although successful replantation involved many factors, the most important factors that directly affected the survival of the amputated digit were surgeon’s experience, venous anastomosis and type of injury.