Secondary Surgeries After Digital Replantations: A Case Series

Matsuzaki, Hiroyuki; Kouda, Hisao; Maniwa, Keiichi

doi:10.1142/s021881041250030x

Cited by 10 publications

(3 citation statements)

References 14 publications

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“…The current analysis evaluated 19 studies representing 1,485 hand and digit replants. 4,14,15,[17][18][19][23][24][25][26][27][28][29][30][31][32][33][34][35] Studies were most frequently published between 1984 and 2018 but included publications from 1978 to 2018. Studies represented a range of geographic locations.…”

Section: Resultsmentioning

confidence: 99%

Characteristics of Secondary Procedures following Digit and Hand Replantation

Shaterian

Sayadi

Anderson

et al. 2019

Journal of Hand and Microsurgery

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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.

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Section: Resultsmentioning

confidence: 99%

Characteristics of Secondary Procedures following Digit and Hand Replantation

Shaterian

Sayadi

Anderson

et al. 2019

Journal of Hand and Microsurgery

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“…In contrast, proximal amputations have been associated with poorer functional outcomes and higher failure rates. 21 We performed distal amputation in only 5 (23.8%) cases, while the majority of cases involved proximal amputations. Remarkably, reasonable postoperative recovery and digit functionality were observed in the majority of proximal amputation cases.…”

Section: Discussionmentioning

confidence: 96%

Microsurgical Digits Replantation in Resource-Limited Setting: A Retrospective Study

Altam,

Obadiel,

Alazaiza

et al. 2024

OAEM

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Background This article aims to share our experiences with microsurgical finger replantation in a resource-limited setting. Methods This multi-institutional, retrospective study included 21 cases of finger amputation that underwent microsurgical replantation, within 7 years period. Patient demographics, preoperative assessments, surgical approaches, and outcomes were documented and analyzed. A univariate analysis was performed to obtain factors associated with digit reimplantation failure. Results Out of 21 cases included, 8 (38.1%) had complete amputations and 13 (61.9%) had incomplete amputations. Crush injuries accounted for the majority (71.4%). On average, 2.2 ± 1.1 digits were affected, with the ring finger being the most commonly injured (71.4%). The mean operative time was 121.5 ± 26.8 minutes. The success rate of digit replantation was 76.2%. During a mean follow-up of 14.3 ± 3.7 months, 85.7% of successfully replanted digits considered their replantation results satisfactory. The majority of replanted digits demonstrated active and effective holding and grasping abilities without pain or instability (76.2%). Replantation failure was associated with a higher number of affected digits (p < 0.001), longer operative time (p = 0.004), complete avulsion (p = 0.003), current smoking (p = 0.025), diabetes (p = 0.006), hypertension (p = 0.047), procedure difficulty score (p= 0.004), and occurrence of complications (p < 0.001). Conclusion Microsurgical finger replantation can yield favorable outcomes and acceptable survival rates, even within resource-limited settings. However, this procedure requires specialized equipment and personnel that may not be available at all institutions. Influential factors in digit replantation failure, include an increased number of damaged digits, extended operative duration, complete avulsion, current smoking, diabetes, hypertension, procedure difficulty score, and postoperative complications occurrence.

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“…After the advance of microsurgery in decades, the survival rates of digital replantation have been reported up to 80% 4 , 5 . A satisfactory range of motion and appearance could also be restored by primary replantation and secondary surgeries, if necessary, in most cases 6 . However, the repair of injured nerve is still challenging in digit replantation.…”

Section: Introductionmentioning

confidence: 99%

Nerve wrap after end-to-end and tension-free neurorrhaphy attenuates neuropathic pain: A prospective study based on cohorts of digit replantation

Zhu

Wei

Zhu

2018

Sci Rep

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The repair of injured peripheral nerve is still challenging for surgeons. The end-to-end and tension-free neurorrhaphy is the current gold standard for reconstruction after complete nerve transection without significant defect. The main objective of this study neurorrhaphy in digit replantation affects the sensory recovery and neuropathic pain in replanted digit. Total 101 patients who received replantation of single completely amputated digit were included for analysis in this study. In group I (n = 49), the digital nerves were repaired with end-to-end and tension-free neurorrhaphy and then wrapped into a tendon-derived collagen nerve conduit. In group II (n = 52), the digital nerves were repaired with end-to-end and tension-free neurorrhaphy only. The static two-point discrimination (s2PD) was performed to evaluate sensory recovery. Visual analog scale (VAS) scores of pain at rest and with exertion were measured respectively. The s2PD tests at three and six months after surgery did not show any significant difference between the two groups. The VAS scores at rest and with exertion of group I were significantly reduced compared with those of group II at three and six months after surgery. Thus, we concluded that nerve wrap into a collagen conduit after end-to-end and tension-free neurorrhaphy could attenuate neuropathic pain after digit replantation but have no benefit for sensory recovery.

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Secondary Surgeries After Digital Replantations: A Case Series

Cited by 10 publications

References 14 publications

Characteristics of Secondary Procedures following Digit and Hand Replantation

Characteristics of Secondary Procedures following Digit and Hand Replantation

Microsurgical Digits Replantation in Resource-Limited Setting: A Retrospective Study

Nerve wrap after end-to-end and tension-free neurorrhaphy attenuates neuropathic pain: A prospective study based on cohorts of digit replantation

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