ORIGINAL RESEARCH ARTICLE

Evaluation of anxiety, depression, and sleep quality in patients following traumatic finger amputation surgery

Kenan Guvenc^a and Sebnem Eker Guvenc^b

^aDepartment of Hand Surgery, Eskişehir City Hospital, Eskişehir, Turkey; ^bDepartment of Family Fhysician, Eskişehir City Hospital, Eskişehir, Turkey

ABSTRACT

Objective: The hand, as one of the most utilized body parts, is particularly vulnerable to trauma. Finger amputations can lead to significant emotional, social, and physical distress.

Methods: This cross-sectional questionnaire study included patients aged 18–75 who underwent surgery following traumatic finger amputation performed by a single surgeon between 2021 and 2022 in a hospital hand surgery clinic. Patients were grouped as follows: Group 1 underwent successful replantation; Group 2 included patients whose fingers were shortened and closed, reconstructed with local flaps, or required secondary surgery due to failed replantation. Evaluations included the Visual Analogue Scale (VAS), Quick Disabilities of the Arm, Shoulder and Hand (QDASH), Beck Anxiety Inventory (BAI), Beck Depression Inventory (BDI), and Pittsburgh Sleep Quality Index (PSQI).

Results: The study included 95 patients, 26 in Group 1 and 69 in Group 2. No significant differences were found between the groups in terms of age or sex (P = 0.570 and P = 0.941, respectively). Group 1 exhibited significantly better pain and functional outcomes based on VAS and QDASH scores (both P < 0.001). Additionally, lower anxiety and depression scores (BAI, BDI) and improved sleep quality (PSQI) were observed in Group 1 (all P < 0.001).

Conclusion: Patients with finger loss due to failed replantation or closure with local flaps should not be regarded as experiencing minor trauma. These patients require comprehensive rehabilitation, pain management, and psychological and social support.

KEYWORDS: Finger amputation; sleep quality; depression; anxiety; replantation

 

 

Introduction

Amputation refers to the removal of a limb or part of a limb due to various causes. The hand, being essential in daily function, is especially prone to traumatic injury [1]. When tissue viability and patient condition permit, microsurgical replantation can be performed [2, 3]. However, the patient’s response and adaptation are influenced by a complex interplay of medical, psychological, and social factors, including the nature of the trauma, patient expectations, social support, personality traits, and cultural context [4]. Finger amputation, although smaller in scale compared to major limb loss, can have profound psychosocial effects. In distal fingertip injuries, treatment options include replantation, primary closure after shortening, flap reconstruction, and skin grafting [5, 6]. These may lead to altered sensation, cold intolerance, and aesthetic concerns. Regardless of size, body integrity loss can negatively impact well-being [7]. Traumatic finger amputation is a significant psychological stressor due to its abrupt and threatening nature [8, 9].

Methods

This study was approved by the institutional ethics committee. It included patients aged 18–75 who underwent surgery after traumatic finger amputation at a single tertiary hospital between 2021 and 2022. Patients were divided into two groups:

• Group 1: Patients who underwent successful replantation
• Group 2: Patients whose fingers were shortened and closed, reconstructed with local flaps, or required secondary procedures after failed replantation

All participants completed standardized questionnaires: VAS for pain, QDASH for function, BAI and BDI for mood assessment, and PSQI for sleep quality.

Results

Ninety-five patients were included, with a mean age of 42.1 ± 14.1 years. Group 1 included 26 patients with successful replantation; Group 2 consisted of 69 patients with finger loss. No significant differences were observed between groups in terms of age or sex. However, Group 1 showed significantly better outcomes across all scales:

• Lower pain (VAS) and improved function (QDASH) (both P < 0.001)
• Lower anxiety and depression scores (BAI, BDI) (both P < 0.001)
• Better sleep quality (PSQI) (P < 0.001) (Table 1)

Table 1. Finger amputation effect on mood and sleep quality.

	Number	Mean	P
PSQI
Group 1	26	0,962 ± 1,2159
Group 2	69	6,826 ± 1,5239	0.000
BAI
Group 1	26	4,308 ± 2,2049
Group 2	69	13,000 ± 4,1124	0.000
BDI
Group 1	26	5,077 ± 1,5981
Group 2	69	15,594 ± 4,9149	0.000
Qdash
Group 1	26	1,319 ± 1,9477
Group 2	69	4,129 ± 5,6534	0.000
VAS
Group 1	26	0,692 ± 5,491
Group 2	69	2,319 ± 0,9624	0.000
VAS: Visual Analog Scale; Qdash: Quickdash score; BAI: Beck Anxiety Inventory; BDI: Beck Depresyon Inventory; PSQI: Pittsburgh Sleep Quality Index.

Discussion

This study demonstrates that successful replantation leads to improved pain, function, mood, and sleep compared to outcomes in patients with permanent finger loss.

It is important to collect preoperative data regarding patients scheduled for planned amputation; such data facilitate the provision of effective nursing care. Patients with comorbidities require more care because of the high risk of postoperative complications [10]. Nurses can assess body image alterations; pain; the risks of falling, bleeding, and infection; nutritional imbalance; deterioration in physical mobility; lack of self-care syndrome; deterioration in social interactions; and social isolation [11]. While all our patients had traumatic rather than elective amputations, this unexpected loss likely exacerbated psychological distress [3]. Supportive care and rehabilitation are essential for recovery. The perceived presence of social support plays a key role in psychological resilience [12]. Multidisciplinary rehabilitation – including physicians, therapists, nurses, psychologists, and family – is vital to optimize recovery [8, 12].

Our findings highlight the necessity of expanding access to replantation services and addressing the psychological burden in patients unable to undergo successful replantation.

Conclusion

Finger amputation due to trauma can lead to lasting psychological and functional consequences. Patients who cannot retain their digits due to surgical failure or alternative closure methods should not be overlooked. Comprehensive care involving physical rehabilitation and psychosocial support should be prioritized for these individuals.

References

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