Preferred Choices for Single-Digit Distal Phalanx Amputation: Decisions of 383 International Microsurgeons (Preprint)
BACKGROUND Replantation is technically demanding and requires long operation time and hospitalization duration, Therefore, replantation for a single digit at the distal phalanx level is not routinely performed. OBJECTIVE There is no definite answer of single-digit distal phalangeal amputation. The purpose of this study is to analyze international microsurgeons' decisions when faced with this common clinical scenario. METHODS A case survey of a right middle finger distal phalanx transverse
... te amputation (Tamai zone II) was conducted via an online and paper questionnaire. Microsurgeons around the world were invited to provide their treatment recommendations. In total, 383 microsurgeons replied, and their responses were stratified and analyzed by geographical areas, subspecialties (hand surgeon / plastic surgeon/orthopedics), had microsurgery fellowship or not, and clinical experiences (number of years as an attending physician). RESULTS Within 383 microsurgeons, 170 (42.3%) chose replantation as their preferred management option, 137 (35.8%) chose revision amputation, 62 (16.2%) chose local flap coverage, and 8 (2.1%) chose composite graft as their reconstruction method for the case study. Microsurgeons from the Asia-Pacific, the Middle East/South Asia, Central/South America regions tent to perform replantation (70.7%, 68.8%, and 67.4%) whereas surgeons from North America and Europe showed a lower preference (20.5% and 26.8%, p<0.001). Having completed a microsurgery fellowship increased the attempt rate of replantation by 15.3% (p=0.004). Clinical experience and the different departments did not show statistical significance in the clinical decision making. CONCLUSIONS From the present study, the geographic preferences and microsurgery fellowship experience influence the method of reconstruction for distal phalanx amputation. Reconstructive decision making is multifactorial, besides the technical aspect, the type of facility and cost-effectiveness of the procedure are also variables to consider. Proper informed consent to include the patient in the decision-making process is also of paramount importance.