“Finger replantation as an office hour procedure: Is overnight delay safe?”

Golash, Anupam; Bera, Sudipta; Kanoi, Aditya; Dey, Deepanjan; Golash, Abhijit; Pai, Ashwin

doi:10.1016/j.bjps.2022.01.016

Cited by 2 publications

(3 citation statements)

References 4 publications

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“…2). 19,37–41 The survival rate for early replanted digits preserved in warm ischemia was 85.7%, whereas cold preservation with a delayed replantation surgery resulted in a significantly increased 91.8% survival rate ( P = 0.01). After calculating a pooled OR, the data identified that digits preserved in cold ischemia for over 12 hours had significantly higher odds of replantation success than the amputated digits replanted with 12 hours or less of warm ischemia time (OR = 1.64; 95% CI = 1.01 to 2.66; P = 0.04).…”

Section: Resultsmentioning

confidence: 99%

“…2). 19,[37][38][39][40][41] The survival rate for early replanted digits preserved in warm ischemia was 85.7%, whereas cold preservation with a delayed replantation surgery resulted in a Meta-analysis diagram of the article collection progression for our meta-analysis. 34 Our initial search term produced a total of 698 articles.…”

Section: Primary Outcomes -Effects Of Temperature and Timementioning

confidence: 99%

“…4). 4,19,25,30,[37][38][39][40][41]44,46 These studies were grouped into three different subgroups based on the method of preservation for the replanted digits: warm ischemia only (Fig. 4, subgroup 1.4.1), late (cold) and warm (early) ischemia (Fig.…”

Section: Primary Outcomes -Effects Of Temperature and Timementioning

confidence: 99%

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Amputated Digit Replantations

Fijany,

Chaker,

Egozi

et al. 2024

Ann Plast Surg

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Introduction A common consideration for replantation success is the ischemia time following injury and the preservation temperature. A classic principle within the hand surgery community describes 12 hours of warm ischemia and 24 hours of cold ischemia as the upper limits for digit replantation; however, these limits are largely anecdotal and based on older studies. We aimed to compare survival data from the large body of literature to aid surgeons and all those involved in the replantation process in hopes of optimizing success rates. Methods The PubMed database was queried on April 4th, 2023, for articles that included data on digit replantation survival in terms of temperature of preservation and ischemia time. All primary outcomes were analyzed with the Mantel-Haenszel method within a random effects model. Secondary outcomes were pooled and analyzed using the chi-square statistic. Statistical analysis and forest plot generation were completed with RevMan 5.4 software with odds ratios calculated within a 95% confidence interval. Results Our meta-analysis identified that digits preserved in cold ischemia for over 12 hours had significantly higher odds of replantation success than the amputated digits replanted with 0–12 hours of warm ischemia time (P ≤ 0.05). The odds of survival in the early (0–6 hours) replantation group were around 40% greater than the later (6–12 hours) replantation group (P ≤ 0.05). Secondary outcomes that were associated with higher survival rates included a clean-cut amputation, increased venous and arterial anastomosis, a repair that did not require a vein graft, and replants performed in nonsmokers (P ≤ 0.05). Discussion Overall, these findings suggest that when predicting digit replantation success, time is of the essence when the digit has yet to be preserved in a cold environment. This benefit, however, is almost completely diminished when the amputated digit is appropriately maintained in a cold environment soon after injury. In conclusion, our results suggest that there is potential for broadening the ischemia time limits for digit replant survival outlined in the literature, particularly for digits that have been stored correctly in cold ischemia.

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Section: Resultsmentioning

confidence: 99%

Section: Primary Outcomes -Effects Of Temperature and Timementioning

confidence: 99%

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Amputated Digit Replantations

Fijany,

Chaker,

Egozi

et al. 2024

Ann Plast Surg

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Influence on emergency digit replantation and outcome assessment after COVID-19 virus nucleic acid testing normalization

Zhang

et al. 2023

Front. Surg.

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ObjectiveThe study aims to compare the implementation and prognosis of emergency digit replantation surgery before and after normalized corona virus disease 2019 (COVID-19) nucleic acid testing for patients taking emergency operation and to explore the influence of normalized COVID-19 nucleic acid testing on replantation surgery.MethodNormalized COVID-19 nucleic acid testing for patients taking emergency operation has been carried out since 1 August 2021 at our hospital, which means each patient who needs emergency surgical treatment has to obtain either positive or negative results of COVID-19 nucleic acid before entering the operating room. This research reviewed and compared the prognosis of the injured extremity that had emergency severed digit replantation between June and September 2021, at the Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, and analyzed the impact of normalized COVID-19 nucleic acid testing on the outcome of the replanted fingers of different severity using disability of arm-shoulder-hand (DASH) and hand injury severity scoring (HISS) scoring systems.ResultsA total of 54 cases with 74 severed replanted phalanges were included replanted by the research group between 1 August and 30 September 2021, without any COVID-19 suspected/confirmed case detected. Compared with previous period (1 June to 31 July, 2021), although the interval between emergency visits and emergency replantation did increase significantly after normalized COVID-19 nucleic acid testing [(3.83 ± 0.94) to (1.77 ± 0.67) h, P < 0.05], we observed no significant difference in the improvement rate of the DASH scoring of the disabled upper extremity 3-month postoperatively (P = 0.538) nor in the complication rate (P = 0.344). Moreover, there was no significant difference in the improvement rate of the DASH scoring of the disabled upper extremity 3-month postoperatively in patients with different traumatic severities before and after normalized COVID-19 nucleic acid testing (moderate P = 0.269, severe P = 0.055, major P = 0.149).ConclusionDespite the preoperative delay, the policy of COVID-19 nucleic acid testing normalization does not have explicit influence on the short-term outcomes of emergency digit replantation surgery. With this evidence, microsurgeons could pay attention to the patients' anxiety and spend more effort in comforting them during the prolonged preoperative wait. These insights may have implications for other emergency department resource management whenever a social crisis occurs.

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“Finger replantation as an office hour procedure: Is overnight delay safe?”

Cited by 2 publications

References 4 publications

Amputated Digit Replantations

Amputated Digit Replantations

Influence on emergency digit replantation and outcome assessment after COVID-19 virus nucleic acid testing normalization

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