Replantation Surgery (original) (raw)
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Long-Term Results of Replantation for Complete Ring Avulsion Amputations
Annals of Plastic Surgery, 2003
Ring avulsion injuries have long presented complex management problems. Despite microsurgical advances, it is difficult to achieve good functional results in complete degloving injuries or amputations, and their management remains somewhat controversial. Ten patients with class IV injuries according to Kay's classification were treated from 1986 to 2000. In this study the authors subdivided class IV injuries into those with amputation distal to the insertion of the flexor digitorum superficialis tendon (class IVd, 5 cases); those with amputation proximal to the insertion of the flexor digitorum superficialis tendon (class IVp, 3 cases); and complete degloving injuries leaving the tendons intact (class IVi, 2 cases). Replantation was done in class IVi and class IVd injuries, and 6 cases were revascularized successfully. In all these patients range of motion was complete at the metacarpal and proximal interphalangeal joints, but reestablishing sensibility was more difficult. Patients with class IVp injuries were treated by surgical amputation of the digit. Modifications of Kay's classification system based on anatomic injury is more predictive of functional outcome for completely amputated ring avulsion injuries. The authors conclude that complete ring avulsion amputations are salvageable, with acceptable functional results in select patients.
Results of Replantation of 33 Ring Avulsion Amputations
The Journal of Hand Surgery, 2013
Purpose Despite microsurgical advances, it is still difficult to achieve satisfactory functional results in cases of replantations following complete ring avulsion amputations. Our aim is to report the experience we have collected since the early 1990s in the treatment of this type of injuries.
Replantation of ring avulsion amputations
Replantation of ring avulsion injuries is a challenge because of the long segment damage to the vessels and intrinsic damage caused to soft tissues at the proximal edge of the amputation. Eight patients with total ring avulsion amputations underwent microsurgical replantation in the period 1994 to 2002. Arterial repair was done by direct vessel suture in three patients, interposition vein grafts in two and cross anastomosis of the digital arteries in three patients. Venous anastomosis was carried out by mobilization and direct suture in seven patients and vessel transfer from the adjacent finger in one patient. Seven of the eight replantations were successful, while one patient had a partial failure. At a minimum follow-up of one year, these patients showed good functional and cosmetic recovery. All successful patients were happy with the outcome and none have requested for amputation, even those whose results were not functionally adequate. However, in addition to technical factors...
Replantation and revascularization vs. amputation in injured digits
Hand (New York, N.Y.), 2013
The purpose of this study was to analyze factors associated with the decision to replant or revascularize rather than amputate an injured digit as well as factors associated with successful replantation or revascularization. We reviewed 315 complete and subtotal amputations at or proximal to the distal interphalangeal joint in 199 adult patients treated over 10 years. Ninety-three digits were replanted (30 %), 51 were revascularized (16 %), and 171 were amputated (54 %), including 5 attempted replantations. Bivariate and multivariable analyses sought factors associated with replantation vs. amputation, revascularization vs. amputation, and success of replantation or revascularization. Factors associated with replantation rather than amputation were injury to the left hand, thumb, middle digit, and ring digit, more than one digit affected, and surgeon. Factors associated with revascularization are surgeon and shorter ischemia time. Forty-five replantations (48 %) and 41 revasculariza...
Indian Journal of Plastic Surgery, 2011
Fingertip amputations are one of the most common injuries faced in an emergency department. Finger tip replantation though technically possible, are not regularly done due to the presumed complexity of the procedure and doubts about the outcome. This article deals with our experience of 24 fingertip replantations in 24 patients done over a period of 8 years since the year 2000. Twentyone fingertips survived. The most common affected digit in the series was thumb followed by index, middle, and ring. The overall success rate was 87%. Both arterial and venous repair were done in all cases. Replantation was not done if no suitable vein was found for anastomosis. Nine patients did not have nerve repair. Seven of them survived and all of them had satisfactory sensation when examined after 1 year. No patient suffered from cold intolerance. All patients were satisfied with the functional outcome and aesthetic appearance. This article highlights the technical considerations and the outcome of these fingertip replants.
The Journal of Hand Surgery, 2010
Purpose To assess the rate of replantation versus revision of amputated fingers in patients air-transported to a tertiary care hand trauma center. Methods We included 40 consecutive subjects (70 digits) who were transported via air after digit(s) amputation distal to the metacarpophalangeal joint. The primary outcome measure was type of surgery (attempted replantation vs revision of the amputation). Data were collected prospectively. Results We identified 3 groups of patients. In group 1 (15 patients, 23 digits), replantation of one or more digits was attempted. In group 2 (6 patients, 8 digits), replantation was not elected. In group 3 (19 patients, 39 digits), no digits were suitable for replantation. The mean age was 36.2 years (range, 5-69 years) and mean time of transport was 5.15 hours (range, 1-24 hours). Mechanisms of finger injury were crush (n ϭ 34), followed by clean cut (n ϭ 15), avulsion/crush (n ϭ 15), and gunshot (n ϭ 6). No significant differences were found between groups for age or time elapsed from injury to hospital arrival. Most patients (n ϭ 25; 65%) transported via air did not undergo replantation surgery. Injury characteristics (n ϭ 18 patients, 72%) were the main reason not to replant. The most common reason for the refusal of replantation was inability to return to work immediately. The most common reasons for surgeon's decision to not to replant were single digit amputations proximal to flexor digitorum superficialis attachment (7 patients), and crush/avulsion type injuries (7 patients), followed by health status and age (5 patients). Conclusions This study shows that a considerable portion of patients transported via air do not undergo replantation surgery. Further studies are needed to establish whether this is an overused service.
The Journal of Hand Surgery, 2006
To compare the functional outcome of successful microsurgical replantation versus amputation closure for single fingertip amputations. Methods: Forty-six fingertip amputations in 46 patients (23 were replanted successfully, 23 had amputation closure) were included in this study. Thumb amputations were excluded. Grip strength and active range of motion of the proximal interphalangeal joint were evaluated. The patients were questioned about their symptoms of pain, paresthesia, and cold intolerance. The Disabilities of the Arm, Shoulder, and Hand questionnaire was given and the disability/symptom score was evaluated. Patients' satisfaction with the surgical result was assessed. Time spent in the hospital and time off from work were reviewed. Results: Active range of motion of the proximal interphalangeal joint was greater in the successful replantation group. Although the existence of paresthesia and cold intolerance were not statistically different between the 2 groups, pain in the affected fingers was more frequent in the amputation closure group. The average Disabilities of the Arm, Shoulder, and Hand score of the successful replantation group was statistically better. All patients in the successful replantation group were highly or fairly satisfied with the surgical results, whereas 14 patients in the amputation closure group were highly or fairly satisfied. The time spent in the hospital and the time off from work for the successful replantation group were longer. Conclusions: Successful replantation of single fingertip amputations can result in minimal pain, better functional outcome, better appearance, and higher patient satisfaction. We recommend attempting fingertip replantation not only to obtain the best appearance but also to gain better functional outcome. If the patient requests the simple surgery and earlier return to work amputation closure is an accepted method despite the disadvantage of digital shortening and the risk for a painful stump. (J Hand Surg 2006;31A:811-818.
Since the first successful salvage of an amputated finger using microsurgical anastomoses in 1965, replan-tation has been widely used in these decades and is now firmly established as a viable treatment option in traumatic limb amputation. The current concepts of replantation surgery for upper limb amputation are discussed in this review article in terms of history of replantation, present indications for the procedure, pre-theater care, technical refinements, postoperative management and functional outcome. In this article , we demonstrated that the advent of microsurgery has led to replantation of almost every amputated part of the upper limb possible. Replantation of digits and the hand can restore not only circulation but also function and cosmetic appearance. However, major amputations remain a challenge and the functional outcome is often disappointing, albeit the success rate of replantation exceeds 80%. Proper patient selection, adequate pre-theater preservation, good operative skill and postoperative care, as well as tight cooperation among the patient, the surgeon, and the rehabilitation therapist will help to achieve a better final functional outcome.