Success of Digital Replantation: Experience of Two U.S. Level-I Trauma Centers

Fufa, Duretti T.; Zeng, Wenyi; Wall, Lindley B.; Calfee, Ryan P.; Goldfarb, Charles A.

doi:10.1016/s0363-5023(12)60050-1

Cited by 32 publications

(69 citation statements)

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“…The overall outcomes of head and neck replanted parts are encouraging. With a complete survival rate of 72.12%, these results are comparable to published data in upper extremity replantation for complex cases (Dec, ; Fufa, Calfee, Wall, Zeng, & Goldfarb, ; Sebastin, & Chung, ). Considering that most amputations included in this systematic review were caused by avulsion‐type mechanisms, successful procedures (complete and partial) of the head and neck ( n = 192, 92.3%) were superior to results found in a meta‐analysis of finger avulsion replants (66.3%) (Dec, ).…”

Section: Discussionsupporting

confidence: 86%

Microvascular replantation of head and neck amputated parts: A systematic review

et al. 2017

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Section: Discussionsupporting

confidence: 86%

Microvascular replantation of head and neck amputated parts: A systematic review

et al. 2017

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“…The latest large study actually reports a success rate of 57% in two academic level-I trauma hospitals. 11,12 These modest results may reflect differences such as a gap in volumes between centers, a more systematic approach encompassing indications to replant, surgeons' experience as well as different cultural and patient experiences in comparison to Asian populations. The 73% success rate reported in our study correlates adequately with the most recent reports from the literature.…”

Section: Discussionmentioning

confidence: 99%

Impact of the number of veins repaired in short-term digital replantation survival rate

Efanov

Rizis

Landes

et al. 2016

Journal of Plastic, Reconstructive & Aesthetic Surgery

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“…In Japan and other parts of Asia, ever expanding indications for finger replantation mean the procedure is performed with increasing frequency. 3,4 In contrast, finger replantation is performed by a small fraction of hand surgeons at only 15% of American hospitals. 5,6 Of the hospitals that do offer replantation procedures, most perform fewer than 10 operations per year.…”

mentioning

confidence: 99%

“…Finger replantation can preserve digit length, nail, and sensate fingertip skin, but the procedure requires a long rehabilitation period and can result in functional deficits owing to persistent finger stiffness especially for injuries in Zone 2. 3,4,9 If the finger is not replanted recovery following revision amputation is relatively short and function is largely retained. 10 However, proximal amputations can cause functional deficits, and psychological problems may arise after amputations at any level.…”

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confidence: 99%

Direct-to-Implant Single-Stage Immediate Breast Reconstruction with Acellular Dermal Matrix

Gdalevitch

Genoway

et al. 2014

Plastic &Amp; Reconstructive Surgery

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Purpose-Large geographic differences in utilization of a procedure draw into question its appropriate use. In Japan, replantation is commonly conducted for even very distal finger amputations. In the US, revision amputation is far more common. There has been no detailed investigation into the drivers of these differences.Methods-We created a survey to assess surgeons' experience with replantation, estimates of physical and functional outcomes, attitudes toward amputees, and preferences in several injury scenarios. The survey was distributed to members of the Finger Replantation and Amputation Multicenter (FRAM) Study and to hand surgeons making podium presentations at the Central Japanese Society for Surgery of the Hand Annual Meeting.Results-100% of both groups responded. There were no significant differences in experience with finger replantation. Japanese hand surgeons were significantly more likely to recommend replantation in all scenarios, despite 62% ranking function 6 months after replantation as "poor." Japanese surgeons rated the appearance of a hand with an amputated finger significantly poorer than American surgeons. Japanese surgeons were also significantly more likely to report stigmatization against finger amputees.Conclusion-There is no high level of evidence study comparing outcomes following replantation and revision amputation. The lack of evidence results in surgeons basing recommendations on personal preference. In this case, Japanese surgeons preferred replantation despite agreeing that functional outcomes were suboptimal. This may be because of Japanese cultural beliefs. Comparative effectiveness research, like that planned by the FRAM study, can help elucidate the appropriate utilization of finger replantation based on evidence.Corresponding author and reprint requests sent to: Kevin C Chung, MD, MS, Professor of Surgery, Section of Plastic Surgery, Assistant Dean for Faculty Affairs, University of Michigan Medical School, 2130 Taubman Center, 1500 W Medical Center Dr, Ann Arbor, MI 48109-0530, Phone: 734-615-3435, kecchung@umich.edu. Hand injuries pose a worldwide burden. Much of the world relies on manual labor such as farming and factory work for sustenance and income. In these cases, revision amputation, which allows for quicker return to work while largely maintaining function, is the preferred treatment. Despite more oversight by many countries in developing safety measure to protect workers, amputation of digits occurs frequently, even in highly developed countries such as the US and Japan. In these regions surgeons are engaged in intense microsurgical training and have access to advanced surgical technology and are able to replant amputated digits successfully. The use of this procedure is variable, however. In Japan and other parts of Asia, ever expanding indications for finger replantation mean the procedure is performed with increasing frequency. 3,4 In contrast, finger replantation is performed by a small fraction of hand surgeons at only 15% of American hospitals. 5,6...

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Success of Digital Replantation: Experience of Two U.S. Level-I Trauma Centers

Cited by 32 publications

References 10 publications

Microvascular replantation of head and neck amputated parts: A systematic review

Microvascular replantation of head and neck amputated parts: A systematic review

Impact of the number of veins repaired in short-term digital replantation survival rate

Direct-to-Implant Single-Stage Immediate Breast Reconstruction with Acellular Dermal Matrix

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