What’s the Claim?
A large, observational study from one center found a substantially increased risk of not just revision amputation but also death when patients underwent digital amputation in the hand for infection as opposed to amputation for traumatic indications. The risk of revision amputation was more than double (34% versus 15%), and the risk of revision went up to 48% among patients with diabetes, peripheral vascular disease, or on dialysis. Perhaps most shockingly, overall survival rates (of the patient, not the rest of the finger) at 2, 5, and 10 years were 79%, 57%, and 18%, which are substantially worse than the overall survival curves in the general population or those seen among patients who underwent finger amputations because of trauma.
How’s It Stack Up?
The general concept here is relatively unsurprising — patients sick enough to get a finger amputation because of infection are likely to have ongoing problems. What struck us is how much of a void this study fills. The authors offered no studies for compare-and-contrast purposes in the article’s Discussion section; I thought this perhaps an oversight, but we couldn’t find any, either. Sporadic, smaller case series about amputations for occlusive arterial disease and of course those about amputations after replantation are out there, but nothing quite like this.