External bleeding versus dermal pocketing for distal digital replantation without venous anastomosis

Lim, Raymond Boon Tar; Lee, Ellen; Lim, Jimmy; Chong, Alphonsus K.S.; Sebastin, Sandeep J.; Foo, Anthony

doi:10.1177/1753193418817979

Cited by 7 publications

(5 citation statements)

References 32 publications

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“…For example, one protocol mandated skin incision every 6 hours for the first 3 days followed by liberalization to every 8 hours through the fifth postoperative day. 33…”

Section: Discussionmentioning

confidence: 99%

“…For example, one protocol mandated skin incision every 6 hours for the first 3 days followed by liberalization to every 8 hours through the fifth postoperative day. 33 Similar to stab incisions, leech therapy also requires frequent changes in the first several postoperative days until weaning can be safely initiated. 34 Drawbacks of leeching include access to therapy, need for antibiotic prophylaxis, and potential for blood transfusion.…”

Section: Comparison Of Decongestive Techniquesmentioning

confidence: 99%

“…This technique is based on establishing passive venous outflow between the replanted part and an uninjured wound bed, and are thought to enhance early neovascularization. 19,33,39 Drawbacks include the need for a Plastic and Reconstructive Surgery • July 2022 donor site, more extensive immobilization, and a secondary procedure for division and inset.…”

Section: Comparison Of Decongestive Techniquesmentioning

confidence: 99%

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Management of Artery-Only Digit Replantation: A Systematic Review of the Literature

Crowe

Tolley

Mauch

et al. 2022

Plastic &Amp; Reconstructive Surgery

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Background: Artery-only replantation may be necessary in circumstances when venous repair cannot be performed due to their size or vessel injury. Venous congestion of the replanted part is inevitable. A systematic review was performed to identify techniques for mitigating congestion and analyze the outcomes of those techniques. Methods: A comprehensive literature search was performed to identify relevant articles related to artery-only replantation. An initial query identified 1286 unique articles. A total of 55 articles were included in the final review. Included studies were categorized by decongestive technique. Data from each article included the number of patients treated, level of amputation, graft use, anticoagulation or antiplatelet therapy, replant viability, and follow-up duration. Weighted averages were determined from studies that reported five or more digits. Results: A total of 1498 individual digital replantations were described. Very rarely did studies report artery-only replantation proximal to the distal interphalangeal joint. An overall survival rate of 78.5 percent was found irrespective of technique but was variable based on each particular study. Studies utilizing medicinal leech therapy were more likely to report use of intravenous anticoagulation, whereas surface bleeding techniques were more likely to report use of topical or local anticoagulant. Conclusions: Lack of a vein for anastomosis should not be regarded as a contraindication to replantation. These digits instead require a method to establish reliable drainage sufficient to allow for low resistance inflow and maintain a physiologic pressure gradient across capillary beds. The surgeon should select a decongestive technique that best suits the patient and their specific injury.

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“…For example, one protocol mandated skin incision every 6 hours for the first 3 days followed by liberalization to every 8 hours through the fifth postoperative day. 33…”

Section: Discussionmentioning

confidence: 99%

Section: Comparison Of Decongestive Techniquesmentioning

confidence: 99%

Section: Comparison Of Decongestive Techniquesmentioning

confidence: 99%

See 1 more Smart Citation

Management of Artery-Only Digit Replantation: A Systematic Review of the Literature

Crowe

Tolley

Mauch

et al. 2022

Plastic &Amp; Reconstructive Surgery

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“…A number of techniques have been described to address venous insufficiency after replantation, including nail plate removal, 5,6 repeated pin pricks for continuous bleeding, 7 and use of leech therapy. 8 In our experience, the amount of bleeding achievable and ease of implementation with this technique is felt to be superior to nail plate removal or leeching.…”

Section: Discussionmentioning

confidence: 99%

Pulp De-epithelialization for Venous Outflow Augmentation after Digital Replantation

Smearman

Chan

Ghareeb

2021

Plastic and Reconstructive Surgery - Global Open

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Summary: Traumatic amputation injuries account for a substantial portion of emergency department visits. This includes digital amputations that may be considered for replantation. Following surgery, venous congestion is the most common cause of replant failure. To address this, several methods have been proposed to augment venous outflow. In this article, a simple and straightforward method that can be utilized to establish or augment venous outflow in cases of venous insufficiency is described. This method entails de-epithelization of the replanted digit pulp skin with use of postoperative anticoagulation. The area can be further expanded or stimulated to increase bleeding as needed and is allowed to heal by secondary intention. This method allows for reliable venous outflow with relative ease of implementation.

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“…The pocket principle can be used to enhance the blood supply and support the survival of the replanted digit by increasing the area of vascular contact. Several successful fingertip non-microsurgical implantations using the pocket technique have been documented in the literature [ [8] , [9] , [10] ].…”

Section: Introductionmentioning

confidence: 99%

A case series study in new restorative surgery in thumb amputation: The Adiposofaciocutaneous flap technique for distal thumb amputation replantation

Ahangar,

Akbaribazm,

Rahimi

et al. 2024

Trauma Case Reports

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External bleeding versus dermal pocketing for distal digital replantation without venous anastomosis

Cited by 7 publications

References 32 publications

Management of Artery-Only Digit Replantation: A Systematic Review of the Literature

Management of Artery-Only Digit Replantation: A Systematic Review of the Literature

Pulp De-epithelialization for Venous Outflow Augmentation after Digital Replantation

A case series study in new restorative surgery in thumb amputation: The Adiposofaciocutaneous flap technique for distal thumb amputation replantation

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