Digital avulsion injuries: epidemiology and factors influencing finger preservation
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HANDSURGERY
Digital avulsion injuries: epidemiology and factors influencing finger preservation Victoria Franziska Struckmann1 · Sebastian Gaus1 · Thomas Schilling2 · Berthold Bickert1 · Ulrich Kneser1 · Leila Harhaus1 Received: 7 May 2020 / Accepted: 2 August 2020 © Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Introduction The surgical treatment of ring avulsion injuries is still challenging. This study provides data concerning epidemiology and factors influencing finger survival rate. We wanted to answer the question whether microsurgical advancement and a high level of surgical expertise nowadays may improve the outcome. Patients and methods Between 11/2007 and 06/2016 95 ring avulsions were treated (classified according to Kay). Complete documentation was available from 87 patients (25 female). The mean age was 34 (4–82) years. Intact perfusion (Kay I) was preoperatively seen in 20 fingers while 67 were avascular (Kay II–IV). Results In 89%, the ring finger was injured during mainly private accidents. Primary amputation was performed in 38 Kay II–IV injuries. Revascularization was applied to 29 fingers while 8 of them (28%) primarily failed. After initially successful revascularization/replantation of 21 fingers, 6 had to be amputated secondarily (success rate: 52%). There was no significant correlation between affected finger and rate of finger preservation. Climbing over a fence as trauma mechanism significantly correlated with lower finger preservation rates and higher incidence of Kay IV injuries. Conclusion Despite microsurgical advances and high levels of surgical expertise the finger survival rate after ring avulsion injuries still seems to be mostly influenced by the extend of intrinsic damage. Keywords Avulsion · Finger survival · Epidemiology
Introduction Finger avulsion injuries have always been a challenge for hand and reconstructive surgeons. During the last decades the advancement in microsurgery led to a fundamental change in the treatment algorithm. In the 1960s and 70 s, pedicled (groin-) and cross-finger flaps were the reconstructive options in order to avoid amputation [3, 7, 13]. Multiple classification schemes have been published on ring avulsion * Victoria Franziska Struckmann victoria.struckmann@bgu‑ludwigshafen.de 1
Department of Hand, Plastic and Reconstructive Surgery, Burn Care Centre, BG Trauma Center Ludwigshafen, Hand and Plastic Surgery, University of Heidelberg, Ludwig‑Guttmann‑Straße 13, 67071 Ludwigshafen, Germany
Department of Trauma, Orthopedic, Hand, Plastic and Reconstructive Surgery, Burn Medicine, German Armed Forces Central Hospital, Ruebenacher Straße 170, 56072 Koblenz, Germany
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injuries. The original classification of finger avulsions was developed by Urbaniak et al. [24] and refined by Kay et al. [12] (Table 1) based on the finding, that avulsions with skeletal injuries led to a worse outcome concerning active range of motion (AROM) and higher rates of amputations [12]. Through further development of microsurgical technique
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