This study reviews 59 consecutive single-finger replantations (excluding thumb) performed at Duke over 7 years, with average follow-up of 53 months. It asks: does the level of amputation relative to the flexor digitorum superficialis insertion predict functional outcome? The answer directly defines the modern indication for single-finger replantation.
When a patient arrives with a single amputated finger, the first question is not 'Can we replant it?' but 'Where did it amputate?'
If the amputation is distal to the FDS insertion, replantation is justified: expect ~82° of PIP motion, return to work in under 2 months, and patient satisfaction with cosmesis. If the amputation is proximal to the FDS insertion, counsel against replantation in most adults: the average PIP motion is only 35° despite subsequent tenolysis and tendon grafting, and these fingers routinely impair overall hand function.
Ring avulsion injuries are a special case — avoid replantation regardless of level, as outcomes are poor whether the amputation is proximal or distal to the FDS. One clinical pearl worth retaining: cold intolerance is nearly universal after replantation but resolves within two years in almost all patients. Do not let this deter you from an otherwise well-indicated replant.
This study reviews 59 consecutive single-finger replantations (excluding thumb) performed at Duke over 7 years, with average follow-up of 53 months. It asks: does the level of amputation relative to the flexor digitorum superficialis insertion predict functional outcome? The answer directly defines the modern indication for single-finger replantation.
When a patient arrives with a single amputated finger, the first question is not 'Can we replant it?' but 'Where did it amputate?'
If the amputation is distal to the FDS insertion, replantation is justified: expect ~82° of PIP motion, return to work in under 2 months, and patient satisfaction with cosmesis. If the amputation is proximal to the FDS insertion, counsel against replantation in most adults: the average PIP motion is only 35° despite subsequent tenolysis and tendon grafting, and these fingers routinely impair overall hand function.
Ring avulsion injuries are a special case — avoid replantation regardless of level, as outcomes are poor whether the amputation is proximal or distal to the FDS. One clinical pearl worth retaining: cold intolerance is nearly universal after replantation but resolves within two years in almost all patients. Do not let this deter you from an otherwise well-indicated replant.