Evidence brief
Indications for Digital Replantation
Thumb replantation almost always indicated
Multiple digit amputations favor replantation
Children have better outcomes
Sharp amputations better than crush/avulsion
Warm ischemia time <6 hours, cold <12 hours for digits
Replantation decision-making balances surgical feasibility against expected functional outcome. Clear indications exist where replantation offers superior outcomes to amputation.
Know absolute indications: thumb, multiple digits, hand at any level, child. Relative: single digit distal to FDS insertion, ring avulsion (Kay classification). Contraindications: single finger proximal to FDS, severe crush, associated life-threatening injury, smoking. Know preservation technique.
Tamai S. Twenty years' experience of limb replantation: review of 293 upper extremity replants. J Hand Surg Am. 1982;7(6):549-556.
Level IV
Case series or case reports