Replant your own index finger? A survey of plastic surgeons and hand therapists in Southeast England

Replant your own index finger? A survey of plastic surgeons and hand therapists in Southeast England Eur J Plast Surg (2008) 31:153 DOI 10.1007/s00238-008-0239-x LETTER TO THE EDITOR Replant your own index finger? A survey of plastic surgeons and hand therapists in Southeast England David Sainsbury & Naveen Cavale & Martin Jones Received: 7 October 2007 /Accepted: 28 February 2008 /Published online: 16 May 2008 Springer-Verlag 2008 Sir, surgeons. There were equivocal responses: 51% stated they Replantation is traditionally indicated for the thumb, single would undergo replantation and 45% said not. Sex or digits distal to the flexor digitorum superficialis insertion, profession did not appear to influence preference for multiple digits and all amputations in children. Absolute replantation. However, six of nine consultant plastic contraindications include concomitant life-threatening inju- surgeons responded that they would not consider replanta- ries, widespread crush or degloving injuries and severe co- tion. Of these, half were hand specialists. The two morbidity. Single digit amputation, extreme contamination, Consultants who stated they would undergo replantation lengthy warm ischemia or micro-arterial diseases are relative were both hand surgeons. contraindications [1]. Avulsion is a controversial area, and Improved hand surgery training and microsurgical some consider it not to be an absolute contraindication. techniques have facilitated increasingly complicated replan- Despite these guidelines, digital replantation remains a grey tations. However, it remains a highly equivocal area with area. Digital survival does not necessarily equate with the indications and contraindications altering little over the success; a stiff, painful finger may be a hindrance. Function past two decades. Whilst we must not become entrenched is often better in distal replantations due to an intact proximal by protocol, maybe it is time to reappraise the guidelines. interphalangeal joint (PIPJ) and tendon apparatus. Yours sincerely, We e-mailed plastic surgeons and hand therapists in Southeast England enquiring whether they would undergo replantation following a clean amputation of their own dominant index finger at the PIPJ. There were 51 References responses. 34 were male consisting of 25 trainee plastic surgeons and nine Consultants. Seventeen females replied, 1. Morrison WA, McCombe D (2007) Digital Replantation. Hand comprising nine hand therapists and eight trainee plastic Clinics 23:1–12 : : D. Sainsbury (*) N. Cavale M. Jones Department of Plastic Surgery, Queen Victoria Hospital, Holtye Road, East Grinstead, West Sussex RH19 3DZ, UK e-mail: sainsburydave@hotmail.com http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png European Journal of Plastic Surgery Springer Journals

Replant your own index finger? A survey of plastic surgeons and hand therapists in Southeast England

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Publisher
Springer-Verlag
Copyright
Copyright © 2008 by Springer-Verlag
Subject
Medicine & Public Health; Plastic Surgery
ISSN
0930-343X
eISSN
1435-0130
D.O.I.
10.1007/s00238-008-0239-x
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See Article on Publisher Site

Abstract

Eur J Plast Surg (2008) 31:153 DOI 10.1007/s00238-008-0239-x LETTER TO THE EDITOR Replant your own index finger? A survey of plastic surgeons and hand therapists in Southeast England David Sainsbury & Naveen Cavale & Martin Jones Received: 7 October 2007 /Accepted: 28 February 2008 /Published online: 16 May 2008 Springer-Verlag 2008 Sir, surgeons. There were equivocal responses: 51% stated they Replantation is traditionally indicated for the thumb, single would undergo replantation and 45% said not. Sex or digits distal to the flexor digitorum superficialis insertion, profession did not appear to influence preference for multiple digits and all amputations in children. Absolute replantation. However, six of nine consultant plastic contraindications include concomitant life-threatening inju- surgeons responded that they would not consider replanta- ries, widespread crush or degloving injuries and severe co- tion. Of these, half were hand specialists. The two morbidity. Single digit amputation, extreme contamination, Consultants who stated they would undergo replantation lengthy warm ischemia or micro-arterial diseases are relative were both hand surgeons. contraindications [1]. Avulsion is a controversial area, and Improved hand surgery training and microsurgical some consider it not to be an absolute contraindication. techniques have facilitated increasingly complicated replan- Despite these guidelines, digital replantation remains a grey tations. However, it remains a highly equivocal area with area. Digital survival does not necessarily equate with the indications and contraindications altering little over the success; a stiff, painful finger may be a hindrance. Function past two decades. Whilst we must not become entrenched is often better in distal replantations due to an intact proximal by protocol, maybe it is time to reappraise the guidelines. interphalangeal joint (PIPJ) and tendon apparatus. Yours sincerely, We e-mailed plastic surgeons and hand therapists in Southeast England enquiring whether they would undergo replantation following a clean amputation of their own dominant index finger at the PIPJ. There were 51 References responses. 34 were male consisting of 25 trainee plastic surgeons and nine Consultants. Seventeen females replied, 1. Morrison WA, McCombe D (2007) Digital Replantation. Hand comprising nine hand therapists and eight trainee plastic Clinics 23:1–12 : : D. Sainsbury (*) N. Cavale M. Jones Department of Plastic Surgery, Queen Victoria Hospital, Holtye Road, East Grinstead, West Sussex RH19 3DZ, UK e-mail: sainsburydave@hotmail.com

Journal

European Journal of Plastic SurgerySpringer Journals

Published: Jul 1, 2008

References

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