Comparing digital replantation versus revision amputation patient reported outcomes for traumatic digital amputations of the hand: A systematic review and <scp>meta‐analysis</scp>

Stone, Nicholas; Shah, Ajay; Chin, Brian; McKinnon, Victoria; McRae, Matthew

doi:10.1002/micr.30738

Cited by 9 publications

(16 citation statements)

References 31 publications

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“…Limited power limited this study, as the replantation surgery is an infrequent occurrence and no prospective national database exists to track occurrence and outcomes. 24,25 A second limitation is with the restraints of the database itself. These include no outcome data other than failure/readmission, no zone of injury documented, mechanism of injury, hospital volume, surgeon volume, and time from injury to surgery, all of which have been demonstrated to be impactful in replantation success.…”

Section: Table 3 Comparisons Between Characteristics Of Patients Unde...mentioning

confidence: 99%

Predictors of Success following Microvascular Replantation Surgery of the Upper Extremity in Adult Patients

Rizzo

Eckhoff

Gonzalez

et al. 2022

Plastic and Reconstructive Surgery - Global Open

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Background:The purpose of this study is to ascertain which factors are associated with successful replantation in the upper extremity. Secondarily, the purpose was to determine patient factors that differentiate those patients who undergo initial replantation versus initial amputation. Methods: Data gathered for this retrospective study were obtained from a custom subset of the 2015-2020 IBM Truven MarketScan Commercial and IBM Truven MarketScan Medicare Supplemental databases. Data were sorted using Current Procedural Terminology codes and International Classification of Disease, Ninth and Tenth Revision, diagnosis codes. Results: Increasing age was significantly associated with undergoing initial amputation compared with replantation (P < 0.001; 95% CI, 47.146-50.654). Among comorbid conditions, patients with diabetes mellitus type II (2.4% versus 24.3%; P < 0.001), hypertension (11.9% versus 28.0%; P = 0.03), end-stage renal disease (0% versus 10.5%; P = 0.03), and hypertensive chronic kidney disease (0% versus 8.7%; P = 0.04) more commonly underwent an initial amputation procedure. When evaluating the need for secondary procedure after replantation, there was no statistical significance between groups when comparing age, gender, insurance type, general comorbidities, connective tissue disorders, mental health disorders, or geographic location. Conclusions:In conclusion, this study demonstrates that age and the presence of comorbidities are important factors in the differentiation of which patients undergo initial reimplantation versus initial amputation. Additionally, no specific factors were identified that were associated with secondary procedures after replantation.

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Section: Table 3 Comparisons Between Characteristics Of Patients Unde...mentioning

confidence: 99%

Predictors of Success following Microvascular Replantation Surgery of the Upper Extremity in Adult Patients

Rizzo

Eckhoff

Gonzalez

et al. 2022

Plastic and Reconstructive Surgery - Global Open

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“…There is also a scarcity of PROM data after revision amputation, and the data that are available suggest that minor disability occurs [8,12,16,21,43,44,48,49]. Other studies reported fewer days of hospitalization, a lower number of secondary operations, and more rapid return to work compared with replantation surgery [5,12,21,43,48]. We therefore wished to evaluate the outcomes of replantation and revision amputation after traumatic distal upper extremity amputation.…”

Section: Introductionmentioning

confidence: 99%

Is Replantation Associated With Better Hand Function After Traumatic Hand Amputation Than After Revision Amputation?

Pyörny,

Luukinen,

Sletten

et al. 2023

Clin Orthop Relat Res

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Background Replantation is an established treatment for traumatic upper extremity amputation. Only a few studies, however, have assessed the patient-reported outcomes of replantation, and the findings of these studies have been conflicting. Questions/purposes (1) Is replantation associated with better hand function than revision amputation? (2) Is replantation associated with better health-related quality of life, less painful cold intolerance, and more pleasing hand esthetics than revision amputation after a traumatic hand amputation? Methods In this retrospective, comparative study, we collected the details of all patients who sustained a traumatic upper extremity amputation and were treated at the study hospital. Between 2009 and 2019, we treated 2250 patients, and we considered all patients who sustained a traumatic amputation of two or more digital rays or a thumb as potentially eligible. Based on that, 15% (334 of 2250) were eligible; a further 2% (8 of 334) were excluded because of a subsequent new traumatic amputation or bilateral amputation, and another 22% (72 of 334) refused participation, leaving 76% (254 of 334) for analysis here. The primary outcome was the DASH score. Secondary outcomes included health-related quality of life (EuroQOL-5D [EQ-5D-5L] Index), painful cold intolerance (the Cold Intolerance Symptom Severity score), and hand esthetics (the Michigan Hand Questionnaire aesthetic domain score). The minimum follow-up time for inclusion was 18 months. Patients were classified into two treatment groups: replantation (67% [171 of 254], including successful replantation in 84% [144 of 171] and partially successful replantation in 16% [27 of 171], in which some but not all of the replanted tissue survived), and revision (complete) amputation (33% [83 of 254], including primary revision amputation in 70% [58 of 83] and unsuccessful replantation followed by secondary amputation in 30% [25 of 83]). In this cohort, replantation was performed if possible, and the reason for choosing primary revision amputation over replantation was usually an amputated part that was too severely damaged (15% [39 of 254]) or was unattainable (2% [4 of 254]). Some patients (3% [8 of 254]) refused to undergo replantation, or their health status did not allow replantation surgery and postoperative rehabilitation (3% [7 of 254]). Gender, age (mean 48 ± 17 years in the replantation group versus 50 ± 23 years in the revision amputation group; p = 0.41), follow-up time (8 ± 4 years in the replantation group versus 7 ± 4 years in the revision amputation group; p = 0.18), amputation of the dominant hand, smoking, extent of tissue loss, or presence of arterial hypertension did not differ between the groups. Patients in the replantation group less frequently had diabetes mellitus (5% [8 of 171] versus 12% [10 of 83]; p = 0.03) and dyslipidemia (4% [7 of 171] versus 11% [9 of 83]; p = 0.04) than those in the revision group and more often had cut-type injuries (75% [129 of 171] versus 60% [50 of 83]; p = 0.02). Results After controlling for potential confounding variables such as age, injury type, extent of tissue loss before treatment, and accident of the dominant hand, replantation was not associated with better DASH scores than revision amputation (OR 0.82 [95% confidence interval (CI) 0.50 to 1.33]; p = 0.42). After controlling for potential cofounding variables, replantation was not associated with better EQ-5D-5L Index scores (OR 0.93 [95% CI 0.56 to 1.55]; p = 0.55), differences in Cold Intolerance Symptom Severity scores (OR 0.85 [95% CI 0.51 to 1.44]; p = 0.79), or superior Michigan Hand Questionnaire esthetic domain scores (OR 0.73 [95% CI 0.43 to 1.26]; p = 0.26) compared with revision amputation. Conclusion Replantation surgery was conducted, if feasible, in a homogenous cohort of patients who underwent amputation. If the amputated tissue was too severely damaged or replantation surgery was unsuccessful, the treatment resulted in revision (complete) amputation, which was not associated with worse patient-reported outcomes than successful replantation. These results contradict the assumed benefits of replantation surgery and indicate the need for credible evidence to better guide the care of these patients. Level of Evidence Level III, therapeutic study.

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“…In prior studies, functional results have been mostly reported after thumb replantation [ 12 – 14 ]. Larger multicenter studies or meta-analyses comparing digital replantation versus revision amputation were recently performed and were based on patient-reported outcomes assessed by questionnaires [ 15 – 17 ]. So far, only a few studies have compared functional outcome and recovery of sensibility between digit replantation and amputation [ 14 , 18 ].…”

Section: Introductionmentioning

confidence: 99%

Functional outcome after digit replantation versus amputation

et al. 2022

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Background The success of digit replantation is mainly based on survival rates. The functional outcome as well as the recovery of sensibility are essential parameters for judging the outcome after digit replantation but have been poorly assessed in previous studies. Patients and methods Forty-eight patients with 56 complete traumatic digit amputations occurring between 2008 and 2013 returned for a follow-up examination, the earliest being 6 months postoperatively. Each patient’s range of motion, fingertip-to-table distance, fingertip-to-palm distance, grip and pinch strengths, static two-point discrimination (2-PD), and Semmes–Weinstein monofilament (SWM) test level were assessed in order to compare functional outcome and recovery of sensibility between successful replantation (n = 19) and primary or secondary amputation (n = 37). Subjective assessments of the pain level and function of the upper extremity were performed using the numerical rating scale and the DASH score, respectively. Results Replanted digits achieved 58% of the median total range of motion of the corresponding uninjured digits. Grip and pinch strength were not significantly different after thumb or finger replantation or amputation. Recovery of sensibility was excellent after replantation, with a median static 2-PD of 5 mm and a reduction of pressure sensibility of two levels of the SWM test compared to the contralateral side. After amputation, the median static 2-PD was also very good, with a median value of 6 mm and a reduction of pressure sensibility of only one level according to the SWM test. There was significantly less pain after replantation at rest (p = 0.012) and under strain (p = 0.012) compared to patients after amputation. No significant differences were observed in the DASH score between the two groups. Conclusion Comparable functional results and sensory recovery but significantly less pain at rest and under strain can be expected after digit replantation when compared to digit amputation. Level of evidence IV.

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Comparing digital replantation versus revision amputation patient reported outcomes for traumatic digital amputations of the hand: A systematic review and meta‐analysis

Cited by 9 publications

References 31 publications

Predictors of Success following Microvascular Replantation Surgery of the Upper Extremity in Adult Patients

Predictors of Success following Microvascular Replantation Surgery of the Upper Extremity in Adult Patients

Is Replantation Associated With Better Hand Function After Traumatic Hand Amputation Than After Revision Amputation?

Functional outcome after digit replantation versus amputation

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