By Joseph Buckwalter V, MD

I recently returned from a 3-month fellowship in China sponsored by the American Society for Surgery of the Hand (ASSH). I had the extraordinary opportunity to participate in the clinical and academic programs of many of their best hand and microsurgical hospitals in Guangzhou, Beijing, Shanghai, and Xi’an.  During my time, I observed the management of both routine and complex hand injuries.  I had many thoughtful discussions with some of the world’s finest hand and microsurgeons regarding routine and complex hand injuries.  We shared similarities and differences in surgical techniques and practice management between the United States and China.

One salient difference is the management of single finger amputation. The decision for replantation of a single finger amputation is always complicated.  Factors including zone of injury, mechanism of injury (sharp, avulsion, or crush), contamination, patient’s age, occupation, and past medical history or other associated injuries strongly influence the decision to perform replantation of the digit.  Additionally, factors regarding duration of recovery and return to work weigh heavily on patients during this time-sensitive decision making process. In the Midwest, where I practice, we treat mainly agricultural and industrial injuries.  Patients are strongly motivated by a rapid return to work.  In general, single finger amputation, especially zone 2 injuries and crush injuries, are a relative contraindication for replantation.

In China, at nearly every hospital I visited, single finger replantation was almost always attempted, regardless of the aforementioned factors surrounding the injury or the anticipated function and recovery post replantation. In discussion with the Chinese surgeons, they universally suggested that cultural differences (possibly the stigma of losing a body part) significantly impact their decisions for replantation, more so than zone of injury or type of injury.

In the current surgical milieu, patient reported outcomes and patient satisfaction are highly valued. Although patient reported outcomes are not routinely collected in China, their post replantation patients appear very satisfied and happy with replantation despite limited function, diminished sensation, and long recovery and rehabilitation times.  This highlights the cultural differences and ultimately, the practice differences in two regions of the world.

My experience in China taught me many things. Regarding replantation of a single digit – I do not know if there is a universally correct treatment plan, however attempting replantation of a single finger is always an option.  During this stressful, time-sensitive time period, our role as hand surgeons is to help our patients navigate this process using our experience as hand surgeons and keeping in mind their goals of functional outcome and return to work.  Just because we can do something, does not mean we should do something.