Characteristics of Secondary Procedures following Digit and Hand Replantation

Abstract

Introduction Secondary procedures following digit and hand replants are often necessary to optimize functional outcomes. To date, the incidence and characteristics of secondary procedures have yet to be fully defined. Materials and Methods A literature search was performed using the NCBI (National Center for Biotechnology Information) database for studies evaluating secondary procedures following digit and hand replantation/revascularization. Studies were evaluated for frequency and type of secondary procedure following replantation. Descriptive statistical analysis was conducted across the pooled dataset. Results Nineteen studies representing 1,485 replants were included in our analysis. A total of 1,124 secondary procedures were performed on the 1,485 replants. Secondary procedures most commonly addressed tendons (27.1%), bone/joints (16.1%), soft tissue coverage (15.4%), nerve (5.4%), and scar contractures (4.5%). A total of 12.7% of replants resulted in re-amputation (16.7% of secondary procedures). The details of secondary procedures are further described in the article. Conclusion Secondary procedures are often necessary following hand and digit replants. Patients should be informed of the possible need for subsequent surgery, including delayed amputation, to improve hand function. These data improve our understanding of replant outcomes and can help patients better comprehend the decision to undergo replantation.

Factors associated with early and late digital revascularization and replantation failure: a retrospective cohort study

“…The restoration of amputated digits has a success incidence in the range of 48%-97% reported for replantation procedures (Sebastin and Chung, 2011;Shaterian et al, 2018). Despite this, these procedures carry high incidences of complication, and >50% undergo secondary procedures (Fufa et al, 2013;Shaterian et al, 2019;Yu et al, 2003). With concerns for suboptimal outcomes and costs attributable to complications, revascularization/replantation procedures (replants) are being performed less frequently and becoming more centralized to academic centres (Cho et al, 2018;Friedrich et al, 2011;Ozer et al, 2010;Sears et al, 2014).…”