Patient Database

A retrospective chart review was performed to identify all patients treated for traumatic finger amputation between 1995 and 2012 at a major hand trauma referral center. An initial screen was performed using ICD-9 codes specific to finger amputations. Because CPT codes are often inadequate to reflect the details of the patient encounter and surgery performed, as well as the success of the revascularization, we reviewed the medical record for each patient identified by ICD-9 code. Inclusion criteria for this study were all patients with amputations distal to the metacarpophalangeal (MCP) joint of any digit, including the thumb, regardless of age. Patients with non-traumatic amputations were excluded from the study. In addition, patients described as having a “tip laceration” or “deep laceration” not resulting in amputation or need for revascularization were excluded from the study. If the patient had a major injury, such as an open long-bone fracture or vascular compromise of the extremity proximal to the MCP joint, or any other condition that influenced the method of transfer, they were excluded. We did not exclude bony or soft tissue injuries at or distal to the metacarpophalangeal joints, whether in the amputated digit(s) or other digits.

Comprehensive demographic information was collected for each patient. Data unique to the traumatic episode included age at time of injury, work-relatedness, method of transfer and transfer distance (when available), ischemia time from injury to presentation at the tertiary care center, season of year, and pre- versus post-2006. Transfer distance was calculated in miles using a straight-line calculation between the outside hospital and the destination trauma center. Summer season was identified based on the 3 months (June, July, August) with the highest average temperature in the region of interest. The winter season was similarly identified as December, January, and February. Injuries were identified as “post-2006” if they occurred after January 31, 2006, as the updated guidelines were published in January 2006. Injuries identified as “pre-2006” occurred on January 31, 2006 or earlier. The outcomes collected included success of revascularization, length of hospital stay, number of re-operations, number of follow-up visits, and post-operative complication percentage for 6 months following the initial injury. Neither hand function scores nor patient satisfaction measures were available. Analysis of return visits was performed separately for patients with successful replantation and patients with a revision amputation, in an effort to avoid confounding from the difference in procedure complexity and need for follow-up. There were no other substantial changes to care protocols or hand trauma management guidelines at our institution during the period of study. This study and the collection of data were approved by an institutional review board.