My brother is a butcher who always prided himself on being careful enough to still have all 10 fingers after 50 years of work. Then last week he had an accident and lost two fingers. They sewed them back on and we are waiting to see if it "takes." It's a little iffy because of his age (67) and a smoking history (he doesn't smoke any more). What are his chances of keeping those two fingers?
Fears that older age (65 or older) increases the risk of complications (including death) from finger replantation can be set aside. According to a recent study from Stanford University, the risk of serious blood clots leading to death after surgery to reattach a thumb or finger in the older age group is no different than in the younger crowd. They determined this by reviewing the medical records of 616 patients across the U.S. who had this surgery done over a 10-year period of time. The data was taken from the Nationwide Inpatient Survey (NIS). Information collected at the time of hospital discharge is placed in this database and can be used by all researchers. No patient is identified, so it is confidential. To give you a little perspective on this topic, compared to the 616 patients over the age of 65 who had a digit replantation, there were almost 15,000 of these procedures done in younger patients (under 65). Age as a risk factor for death following digit replantation just wasn't a factor. But that doesn't mean that age should be ignored. Older adults who had a digit replantation were twice as likely to need a blood transfusion. Discharge to a nursing home rather than directly to the patient's home was also more likely in the older age group. Although this study did not analyze survival rates of the finger (or thumb), other studies have reported no difference based on age. Patients with diabetes or who smoke are at risk for less optimal outcomes compared with those without these risk factors. The effect of a past history of smoking on the success of finger replantation has not been studied. But the low rate of overall complications suggests this isn't a big factor. Survival of the digit is one variable; function is something else. In other words, the patient may not lose the finger but he or she may not have good use (function) of the digit. Survival versus function was not studied in this particular study and may be the basis of future studies. On the positive side of things, surgery today has advanced to the point that replantation is possible with microsurgery. Rehabilitation under the guidance of a highly trained hand therapist has made it possible to regain function as well. With a team effort, your brother is likely to have a very good result.