Return-to-Work After Attempted Digit Replantation: A Systematic Review of 31 Studies

BACKGROUND: Traumatic digit amputation is a common injury with life-altering consequences for thousands of patients each year. In this study, we aim to update and expand the reported outcomes of return-to-work (RTW) and functional recovery in patients treated with digit replant after traumatic amputation. METHODS: A PRISMA-guided systematic review was performed to identify all published articles related to digit replantation following amputation. We queried the following 4 databases: Scopus, Embase, Web of Science, and PubMed-MEDLINE. A total of 31 studies were included in the analysis of return-to-work data. RESULTS: Of the 31 included studies, 26 studies reported that 1976 digits were successfully replanted, while 27 studies reported that 300 replants failed (86.8% success rate). Among 1087 patients in these studies, 82.9% who underwent replantation returned to work. The mean RTW time in 16 studies was 4.7 months (weighted average). Return-to-work time ranged from 0 to 26 months in 12 studies. Of 352 patients who returned to work in 17 studies, 90.9% resumed their previous occupation, while 29 (8.2%) changed occupations. The RTW for finger-only replantations was significantly lower compared to thumb-only, distal digit-only, and any digit replantations (66.0% vs 82.8%; 66.0% vs 87.6%; 66.0% vs 82.9%). CONCLUSION: Despite a declining prevalence of digit replantation surgery in recent years, this study illustrates that replantation provides beneficial outcomes for patients with a high return-to-work rate.

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A systematic review of 31 studies found 82.9% of 1087 digit-replantation patients returned to work, with a weighted mean return time of 4.7 months; finger-only replantations had lower return-to-work rates than thumb-only or distal digit replantations.

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