Factors affecting healing and survival after finger amputations in patients with digital artery occlusive disease

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Abstract

Background: Finger amputations are typically performed as distal as possible to preserve maximum finger length. Failure of primary amputation leads to additional procedures, which could potentially be avoided if a more proximal amputation was initially performed. The effect of single versus multiple procedures on morbidity and mortality is not known. We evaluated factors that predicted primary healing and the effects of secondary procedures on survival. Methods: Patients undergoing finger amputations from 1995 to 2011 were evaluated for survival with uni- and multivariate analysis of demographic data and preoperative vascular laboratory studies to assess factors influencing primary healing. Results: Seventy-six patients underwent 175 finger amputations (range 1 to 6 fingers per patient). Forty-one percent had diabetes, 33% had nonatherosclerotic digital artery disease, and 29% were on dialysis. Sex distribution was equal. Primary healing occurred in 78.9%, with the remainder requiring revisions. By logistic regression analysis, nonatherosclerotic digital artery disease was associated with failure of primary healing (odds ratio = 7.5; 95% confidence interval, 1.03 to 54; P =.047). Digital photoplethysmography did not predict primary healing. The overall healing of primary and secondary finger amputations was 96.0%. The mean survival after the initial finger amputation was 34.3 months and did not differ between patients undergoing single (35.6 months) versus multiple procedures (33.6 months). Dialysis dependence was associated with decreased survival (hazard ratio = 2.9; 95% confidence interval, 1.13 to 7.25; P =.026). Conclusions: Failure of primary healing is associated with the presence of nonatherosclerotic digital artery disease and is not predicted by digital photoplethysmographic studies. Dialysis dependence is associated with decreased survival in patients with finger amputations, but failure of primary healing does not adversely affect survival. A strategy of aggressive preservation of finger length is appropriate for most patients.

Original languageEnglish (US)
Pages (from-to)566-570
Number of pages5
JournalAmerican Journal of Surgery
Volume205
Issue number5
DOIs
StatePublished - May 2013

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Amputation
Fingers
Arteries
Survival
Dialysis
Photoplethysmography
Confidence Intervals
Sex Distribution
Blood Vessels
Multivariate Analysis
Logistic Models
Odds Ratio
Regression Analysis
Demography
Morbidity
Mortality

Keywords

  • Amputation
  • Chronic kidney disease
  • Connective tissue disease
  • Diabetes mellitus
  • Finger
  • Scleroderma

ASJC Scopus subject areas

  • Surgery

Cite this

@article{232867034de44c6990f63dfd192c1c74,
title = "Factors affecting healing and survival after finger amputations in patients with digital artery occlusive disease",
abstract = "Background: Finger amputations are typically performed as distal as possible to preserve maximum finger length. Failure of primary amputation leads to additional procedures, which could potentially be avoided if a more proximal amputation was initially performed. The effect of single versus multiple procedures on morbidity and mortality is not known. We evaluated factors that predicted primary healing and the effects of secondary procedures on survival. Methods: Patients undergoing finger amputations from 1995 to 2011 were evaluated for survival with uni- and multivariate analysis of demographic data and preoperative vascular laboratory studies to assess factors influencing primary healing. Results: Seventy-six patients underwent 175 finger amputations (range 1 to 6 fingers per patient). Forty-one percent had diabetes, 33{\%} had nonatherosclerotic digital artery disease, and 29{\%} were on dialysis. Sex distribution was equal. Primary healing occurred in 78.9{\%}, with the remainder requiring revisions. By logistic regression analysis, nonatherosclerotic digital artery disease was associated with failure of primary healing (odds ratio = 7.5; 95{\%} confidence interval, 1.03 to 54; P =.047). Digital photoplethysmography did not predict primary healing. The overall healing of primary and secondary finger amputations was 96.0{\%}. The mean survival after the initial finger amputation was 34.3 months and did not differ between patients undergoing single (35.6 months) versus multiple procedures (33.6 months). Dialysis dependence was associated with decreased survival (hazard ratio = 2.9; 95{\%} confidence interval, 1.13 to 7.25; P =.026). Conclusions: Failure of primary healing is associated with the presence of nonatherosclerotic digital artery disease and is not predicted by digital photoplethysmographic studies. Dialysis dependence is associated with decreased survival in patients with finger amputations, but failure of primary healing does not adversely affect survival. A strategy of aggressive preservation of finger length is appropriate for most patients.",
keywords = "Amputation, Chronic kidney disease, Connective tissue disease, Diabetes mellitus, Finger, Scleroderma",
author = "Gregory Landry and Ashley McClary and Timothy Liem and Erica Mitchell and Amir Azarbal and Moneta, {Gregory (Greg)}",
year = "2013",
month = "5",
doi = "10.1016/j.amjsurg.2013.01.019",
language = "English (US)",
volume = "205",
pages = "566--570",
journal = "American Journal of Surgery",
issn = "0002-9610",
publisher = "Elsevier Inc.",
number = "5",

}

TY - JOUR

T1 - Factors affecting healing and survival after finger amputations in patients with digital artery occlusive disease

AU - Landry, Gregory

AU - McClary, Ashley

AU - Liem, Timothy

AU - Mitchell, Erica

AU - Azarbal, Amir

AU - Moneta, Gregory (Greg)

PY - 2013/5

Y1 - 2013/5

N2 - Background: Finger amputations are typically performed as distal as possible to preserve maximum finger length. Failure of primary amputation leads to additional procedures, which could potentially be avoided if a more proximal amputation was initially performed. The effect of single versus multiple procedures on morbidity and mortality is not known. We evaluated factors that predicted primary healing and the effects of secondary procedures on survival. Methods: Patients undergoing finger amputations from 1995 to 2011 were evaluated for survival with uni- and multivariate analysis of demographic data and preoperative vascular laboratory studies to assess factors influencing primary healing. Results: Seventy-six patients underwent 175 finger amputations (range 1 to 6 fingers per patient). Forty-one percent had diabetes, 33% had nonatherosclerotic digital artery disease, and 29% were on dialysis. Sex distribution was equal. Primary healing occurred in 78.9%, with the remainder requiring revisions. By logistic regression analysis, nonatherosclerotic digital artery disease was associated with failure of primary healing (odds ratio = 7.5; 95% confidence interval, 1.03 to 54; P =.047). Digital photoplethysmography did not predict primary healing. The overall healing of primary and secondary finger amputations was 96.0%. The mean survival after the initial finger amputation was 34.3 months and did not differ between patients undergoing single (35.6 months) versus multiple procedures (33.6 months). Dialysis dependence was associated with decreased survival (hazard ratio = 2.9; 95% confidence interval, 1.13 to 7.25; P =.026). Conclusions: Failure of primary healing is associated with the presence of nonatherosclerotic digital artery disease and is not predicted by digital photoplethysmographic studies. Dialysis dependence is associated with decreased survival in patients with finger amputations, but failure of primary healing does not adversely affect survival. A strategy of aggressive preservation of finger length is appropriate for most patients.

AB - Background: Finger amputations are typically performed as distal as possible to preserve maximum finger length. Failure of primary amputation leads to additional procedures, which could potentially be avoided if a more proximal amputation was initially performed. The effect of single versus multiple procedures on morbidity and mortality is not known. We evaluated factors that predicted primary healing and the effects of secondary procedures on survival. Methods: Patients undergoing finger amputations from 1995 to 2011 were evaluated for survival with uni- and multivariate analysis of demographic data and preoperative vascular laboratory studies to assess factors influencing primary healing. Results: Seventy-six patients underwent 175 finger amputations (range 1 to 6 fingers per patient). Forty-one percent had diabetes, 33% had nonatherosclerotic digital artery disease, and 29% were on dialysis. Sex distribution was equal. Primary healing occurred in 78.9%, with the remainder requiring revisions. By logistic regression analysis, nonatherosclerotic digital artery disease was associated with failure of primary healing (odds ratio = 7.5; 95% confidence interval, 1.03 to 54; P =.047). Digital photoplethysmography did not predict primary healing. The overall healing of primary and secondary finger amputations was 96.0%. The mean survival after the initial finger amputation was 34.3 months and did not differ between patients undergoing single (35.6 months) versus multiple procedures (33.6 months). Dialysis dependence was associated with decreased survival (hazard ratio = 2.9; 95% confidence interval, 1.13 to 7.25; P =.026). Conclusions: Failure of primary healing is associated with the presence of nonatherosclerotic digital artery disease and is not predicted by digital photoplethysmographic studies. Dialysis dependence is associated with decreased survival in patients with finger amputations, but failure of primary healing does not adversely affect survival. A strategy of aggressive preservation of finger length is appropriate for most patients.

KW - Amputation

KW - Chronic kidney disease

KW - Connective tissue disease

KW - Diabetes mellitus

KW - Finger

KW - Scleroderma

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U2 - 10.1016/j.amjsurg.2013.01.019

DO - 10.1016/j.amjsurg.2013.01.019

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EP - 570

JO - American Journal of Surgery

JF - American Journal of Surgery

SN - 0002-9610

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