Assessment of Functional Outcomes Following Successful Finger Replantation

Primary outcomes

1. Range of motion (ROM)

   Time frame: At least 6 months after replantation

   A goniometer will be used to determine the range of motion (ROM) of the metacarpophalangeal and interphalangeal joints of the replanted digits.

2. Finger flexion and extension of replanted digits

   Time frame: At least 6 months after replantation

   The fingertip-to-palm distance (FPD) and fingertip-to-table distance (FTD) will be used to assess deficits in finger flexion and extension of replanted digits.

3. Grip and pinch strengths

   Time frame: At least 6 months after replantation

   Jamar hand dynamometer will be used to determine the grip and pinch strengths. Grip and pinch measurements will be taken in the standardized sitting position with the shoulder of the patient kept in the neutral position and the elbow flexed to 90°.

4. Recovery of sensibility

   Time frame: At least 6 months after replantation

   The static two-point discrimination (2-PD) and Semmes-Weinstein monofilament test (SWM test) will be used to evaluate the sensory recovery of the radial and ulnar digital nerves of all injured fingers. Normal sensibility is defined as the sensibility assessed at the corresponding contralateral uninjured digits. The two-point discriminator consists of a plate with several pins with adjustable separations ranging from 1 to 15 mm in steps of 1 mm. The patients will be asked to close their eyes during the examination. One or two pins will be applied perpendicularly to the radial and ulnar finger pulp and held for at least 3 seconds. Three repeated responses will be necessary for the final score.

5. Pain intensity

   Time frame: At least 6 months after replantation

   Only patients with a single-digit injury will be included for these evaluations. This is because patients with multiple-digit injuries will be expected to have a higher pain level than patients with a single-digit injury and their inclusion would, therefore, bias the results. On a scale from 0 to 10, the pain intensity at rest, under strain, and in cold temperatures will be reported, with a higher number indicating increased pain.

6. DASH score

   Time frame: At least 6 months after replantation

   The disability of the arm, shoulder, and hand (DASH) questionnaire will be used for subjective evaluations. Only patients with a single-digit injury will be included for these evaluations. This is because patients with multiple-digit injuries will be expected to have a higher DASH score than patients with a single-digit injury and their inclusion would, therefore, bias the results. The DASH questionnaire contains 30 questions on daily living activities for assessing the patient's disabilities in the upper extremities. Each question is scored on a five-point scale from 1 to 5. The score calculation ranged from 0 to 100, while a higher DASH score indicated increased disability. At least 27 of the 30 items will be needed to obtain a valid score.