Long-term follow-up results of 97 finger replantations

Glas, Karl; Biemer, E.; Duspiva, K. P.; Werber, K. D.; Stock, Wolfgang G.; Herndl, E.

doi:10.1007/bf00462345

Cited by 10 publications

(3 citation statements)

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“…Therefore, during fingertip amputations, if the amputated segment is in a good condition and is preserved very well during transportation, then for excellent esthetical and functional results, replantation is the gold standard intervention. [6] Though success rates of replantation range between 80% and 90%, [7][8][9] depending on the amputed segment, replantation cannot be performed every time. If replantation is not performed, the patient is left to secondary healing, and this results in the patient taking a long time to return to his/her routine daily life and appearance of the fingertip may not be satisfactory in aesthetic and functional aspects.…”

Section: Discussionmentioning

confidence: 99%

Comparisons between long-term outcomes of the use of reposition flaps and replantations in fingertip amputations

Sır¹,

Aksoy²,

Aksoy³

2018

Ulus Travma Acil Cerrahi Derg

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BACKGROUND: Replantation is the gold standard procedure for traumatic amputation of fingertips. Reposition flap procedure is performed using nail-bone complex as a free graft and covering graft site with a flap to preserve original finger length, nail complex, and sensory functions of fingertip in pateints where microsurgical methods cannot be applied. In our study, we aimed to compare the long-term outcomes of patients with amputated fingertips who underwent replantation or reposition flap procedures. METHODS: Thirty-five patients of replantation and 28 patients of reposition flap procedures only for 2 nd , 3 rd , and 4 th fingertip amputations were included in the study. Complete fingertip amputations involved Foucher zones 2 and 3. The patients were followed up postoperatively for a median period of 13 months (9-23 months). All patients were assessed with static and dynamic 2-point discrimination tests, Semmes-Weinstein monofilament test, and cold intolerance test for the development of neuroma on the donor site. RESULTS: In 5 patients, replantation procedure failed. In such failed patients, after the removal of necrotic tissues, the stump was either repaired or reconstruction with a flap was applied. Wound dehiscence was observed at the lateral sides of the flaps in 2 patients who underwent reposition procedures. CONCLUSION: Reposition flap repair can be a good cost-effective alternative to other fingertip repair procedures in appropriately selected patients who are not amenable to microsurgery. It preserves the length and sensory functions of fingertips and enables patients to return to their daily life as soon as possible.

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Section: Discussionmentioning

confidence: 99%

Comparisons between long-term outcomes of the use of reposition flaps and replantations in fingertip amputations

Sır¹,

Aksoy²,

Aksoy³

2018

Ulus Travma Acil Cerrahi Derg

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“…A lot of studies combine both total and subtotal amputations in their series, which makes it impossible to extract comparable outcomes. [4][5][6][7] Biemer suggested classifying subtotal amputations into five subtypes based on the structures that remained intact (►Table 1). 8 Although this approach is rational, it allows for more than 30 different combinations of injuries that add much more complexity in the functional assessments.…”

Section: Challenges In Measuring Outcomes Following Digital Replantatmentioning

confidence: 99%

“…The traditional outcome measures (sensation, range of motion, and grip/ pinch strength) vary widely among publications. For example, some authors report two-point discrimination (2-PD) for sensation, 4,11 whereas others use monofilament testing. Ideally, both parameters should be measured, as they measure different aspects of sensation.…”

Section: The Operationmentioning

confidence: 99%

Challenges in Measuring Outcomes Following Digital Replantation

Sebastin

Chung

2013

Seminars in Plastic Surgery

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A right-handed 20-year-old construction worker sustained a crush amputation of his right middle finger at work. He has no other associated injuries and is in good health. He was seen at the hospital 1 hour after his injury and underwent a successful replantation procedure. He eventually developed a stiff insensate digit, which prevented him from returning to work. One year later and following two secondary procedures, much therapy, and use of significant health care resources, he still had not returned to work. Eventually, he underwent a ray amputation of the digit. Although the replantation was successful, it worsened the patient's existing function.The common tendency to equate digit survival with success is erroneous. Success must be measured in terms of the contribution of the replanted digit to subsequent overall performance of the patient.1 Mortality in digital replantation is rarely an issue, so the end result of the interventions should be functional gain. 2 In the presented case, success is attained at the cost of the patient's functional outcome. In today's consumer-driven medical environment, patients and payers demand reliable data that can help them make informed medical decisions that lead to cost-effective medical practices. The literature regarding digital replantation surgery is full of personal case series and anecdotal experience, which is no longer an acceptable platform for making medical decisions. Patients want more information not only about surgical outcomes and functional recovery, but also about the delivery of care, psychological and social wellbeing, and the aesthetic appearance.3 Outcomes research provides patients with this information. In this article, we will summarize the challenges in assessing outcomes of digital replantation and suggest measures to improve the reporting of outcomes. Keywords► digital replantation ► outcome of replantation ► research design ► health-related quality of life instruments ► cost effectiveness AbstractIn the early period of replantation surgery, the emphasis was on digit survival. Subsequently, with better microsurgical techniques and instrumentation, the focus has shifted to function and in recent years to consideration of cost-effectiveness. Despite over 40 years of effort in refining digital replantation surgery, a rigorous evaluation of the outcomes of digital replantation has not been performed. This is because of the many confounding variables that influence outcome comparisons. These variables include the mechanism of injury (guillotine, crush, avulsion), the injury itself (total, near total, subtotal, partial amputation), and the surgical procedure (replantation, revascularization). In addition, the traditional outcome measures (two-point discrimination, range of motion, grip strength, or the ability to return to work) are reported inconsistently and vary widely among publications. All these factors make meaningful comparison of outcomes difficult. The recent emphasis on outcome research and cost-effectiveness necessitates a rethinking in t...

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One hundred sixty-seven thumb replantations and revascularisations: Early microvascular results

et al. 1996

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One hundred sixty-seven thumb replantations and revascularisations were performed from 1977 to 1987 by the Ljubljana microsurgical team. Early microvascular results of thumb replantations and early reoperations were analysed retrospectively. Age of the patients, level of traumatic amputation, mechanism of injury, use of arterial grafts, severity (total-subtotal) of amputation and occurrence of thrombosis were potential survival factors analysed with logistic regression analysis. The overall success rate for this series was 66% (72% for failures to revascularise excluded). The most frequent cause of failure was venous thrombosis. The most critical time for failure was the first 4 days after the replantation. No microvascular complication occurred later than the seventh day and no reoperation was successful later than the third day after replantation. Survival factors were studied with logistic regression analysis which showed that the model was not statistically significant. However, estimation of relative risks gave us useful but statistically uncertain information regarding the survival factors inspected.

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Long-term follow-up results of 97 finger replantations

Cited by 10 publications

References 1 publication

Comparisons between long-term outcomes of the use of reposition flaps and replantations in fingertip amputations

Comparisons between long-term outcomes of the use of reposition flaps and replantations in fingertip amputations

Challenges in Measuring Outcomes Following Digital Replantation

One hundred sixty-seven thumb replantations and revascularisations: Early microvascular results

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