Incidence and Timing of Complications Requiring Secondary Revision after Primary Revision of Traumatic Digit Amputations
Andrew Paul Harris, MD; Neill Y Li, MD; Avi D Goodman, MD; Joseph Gil, MD; Jeremy Raducha, MD; Julia A. Katarincic, MD
Brown University, Providence, RI
While complications requiring secondary revision after primary revision of traumatic digit amputations have been reported, most series have been limited. Therefore, we aimed to describe the incidence and timing of complications necessitating secondary revision after primary revision digit amputation in a large series.
MATERIALS AND METHODS
After IRB approval, our institutionŐs Emergency Department (ED) database was retrospectively examined for all patients presenting with traumatic finger and thumb amputations from January 2010 to December 2015. All patient information was entered into REDCap, including demographic information, handedness, work related injury, medical comorbidities, mechanism of injury, Verdan flexor tendon zone(s) of amputation, site of initial definitive management (ED versus operating room), and the type and timing of complications requiring unplanned secondary revision amputation.
RESULTS: 537 patients with 677 traumatic digit amputations were initially treated with primary revision amputation. 81 (15.1%) patients with 91 (13.4%) digit amputations underwent unplanned secondary revision for at least one complication (TABLE 1). Of these, complications included: 32 digits (4.7% of all digits) with soft tissue coverage at an average of 28 days (range 2-241 days), 21 digits with nail deformity at an average of 179 days (range 42-671 days), 9 digits with neuroma at an average of 215 days (range 42-503 days), 7 digits with neuroma and nail deformity at an average of 133 days (range 37-242 days). Other infrequent complications included nail deformity and cosmesis (4, average 144 days), cosmesis alone (4, average 140 days), scar contracture and function (3, average 378 days), scar contracture (4, average 195 days), infection and soft tissue coverage (2, average 15 days), and 1 digit complicated by neuroma and cosmesis, neuroma and soft tissue coverage, cosmesis and soft tissue coverage, and infection at 707, 91, 10, and 22 days respectively (FIGURE 1).
Following primary revision digit amputation, the incidence of all complications requiring secondary revision was 15.1% of patients and 13.4% of digits.
Soft tissue coverage was the most common early complication that required secondary revision, affecting 4.7% of primarily revised digits at an average of 28 days after the index procedure.
Neuroma and nail deformity were the two most common late presenting complications requiring secondary revision at an average of 215 and 179 days respectively.
At the time of index procedure, the patient may be counseled on the potential complications requiring secondary revision and the timing of such complications.
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