Microsurgical Digital Replantation in Traumatic Amputations: Systematic Review

Abstract

Introduction: Traumatic digital amputations impair hand function and cause sensory–aesthetic sequelae; microsurgical replantation aims to restore tissue viability and meaningful function.

Objective: To synthesize the evidence published between 2020 and 2025 on survival, function, and complications after microsurgical digital replantation and, when comparative studies are available, contrast these outcomes with those reported for revision amputation.

Methods: Systematic review following PRISMA 2020. Searches were conducted in MEDLINE/PubMed, Embase, Scopus, and the Cochrane Library, with complementary grey-literature screening (reference lists and trial registries when applicable), from January 1, 2020, to the search date. Two reviewers independently selected studies, extracted standardized data, and assessed risk of bias using validated tools. A narrative synthesis was performed and supported by quantitative estimates when appropriate.

Results: A total of 142 records were identified; after removing 38 duplicates, 104 records were screened, 42 full texts were assessed, and 26 studies were included. Overall replant survival was approximately 85% in recent comparative analyses. Functional recovery was heterogeneous, with lower range of motion than the contralateral side in mixed series but a more favorable pain profile in some studies. The most frequent complications were vascular (arterial/venous insufficiency and venous congestion), managed through early re-exploration and venous outflow strategies.

Conclusions: Digital replantation achieves high survival and potential functional benefit in selected cases; digit/level-specific selection and early salvage are key. Evidence heterogeneity and non-standardized outcomes remain major limitations, supporting the need for prospective multicenter studies.