From the Research
A relative contraindication for finger replantation in a patient with digit amputation is a single-digit amputation proximal to the insertion of the flexor digitorum superficialis tendon, particularly in the index, middle, or ring fingers. This is based on the most recent and highest quality study available, which suggests that such amputations may result in limited functional recovery despite successful vascular anastomosis 1. The flexor digitorum superficialis insertion is an important anatomical landmark, as amputations proximal to this point often lead to poor tendon excursion and inadequate finger flexion post-replantation.
Key Considerations
- Amputations proximal to the flexor digitorum superficialis insertion are associated with poor functional outcomes due to limited tendon excursion and finger flexion 2, 3.
- Other relative contraindications include severe crushing or avulsion injuries with extensive tissue damage, prolonged warm ischemia time (generally beyond 12 hours), significant medical comorbidities that increase surgical risk, and patients with psychiatric conditions or compliance issues that might compromise rehabilitation 4, 5.
- The decision to replant should be individualized, weighing factors such as the patient's age, hand dominance, occupation, and functional needs against the technical feasibility and expected outcomes.
Relevant Evidence
- A study published in 2020 found that multidigit replantation can achieve good survival rates and functional outcomes, even in cases with amputations proximal to the flexor digitorum superficialis tendon 1.
- Another study published in 2015 noted that relative indications for replantation in the upper extremity include amputation of the thumb or multiple digits, as well as amputations proximal to zone II and pediatric finger amputations at any level 5.
Clinical Implications
- The patient's condition, including the presence of alcohol intoxication, should be carefully evaluated to determine the best course of treatment. However, alcohol intoxication is not a direct contraindication for replantation, and the decision should be based on the individual patient's needs and the technical feasibility of the procedure.
- Other reconstructive options, such as revision amputation or toe-to-hand transfer, may be considered to optimize hand function if replantation is not performed or is not successful.