Digital replantation/revascularization: predictive factors to microsurgery success—a single-center study

Abstract

Purpose

Success rate in replantation/revascularization digital surgery is one of the challenges of reconstructive surgery. For this reason, investigating prognostic factors for survival and improvement of outcomes is highly relevant. The goal of this study was to establish predictive factors of survival in replantation/revascularization digital surgery.

Methods

A descriptive, retrospective study was performed in patients who underwent urgent replantation/revascularization digital surgery in our center between January 2007 and July 2017. A total of 116 patients and 157 digits were included. Outcome (survival) factors evaluated were: preoperatively: age, sex, body mass index (BMI), ASA anesthesia score, comorbidities (smoking status, diabetes mellitus, hypertension), coagulation, type of lesion, number of affected digits, position of affected digits, injury mechanism, ischemia time; time between accident and the surgery; intraoperatively: anesthetic technique, fluid therapy (administered volume), length of surgery; and postoperatively: post-surgical complications, re-intervention requirements, surgical success rate. Statistical analysis was performed to evaluate outcome and elicit predictive factors.

Results

157 digits from a total of 116 patients were included. Statistically significant differences regarding predictors of survival of replantation were found in ischemia time (0 0.003), length of surgery (p 0.004), post-surgical complications (p 0.000) and replantation need (p 0.000). The rest of analyzed variables were not statistically significant (p > 0.05). Revascularization surgery had a greater success rate than replantation (p 0.001).

Conclusions

Success rate in traumatic digital surgery is greater when revascularization surgery is performed, rather than replantation. Preoperative ischemia time, length of surgery, postoperative complications and re-intervention requirement are the factors that affect survival rate.

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References

  1. 1.

    Zumiotti A, Ferreira MC. Replantation of digits: factors influencing survival and functional results. Microsurgery. 1994;15(1):18–211.

    CAS  Article  Google Scholar 

  2. 2.

    Chen YC, Chan FC, Hsu CC, et al. Fingertip replantation without venous anastomosis. Ann Plast Surg. 2013;70(3):284–8.

    CAS  Article  Google Scholar 

  3. 3.

    Wang LH, Zhang GQ. Use of digital subtraction angiography for assessment of digital replantation. J Zhejiang Univ Sci B. 2012;13(3):209–12.

    CAS  Article  Google Scholar 

  4. 4.

    Li J, Guo Z, Zhu Q, et al. Fingertip replantation: determinants of survival. Plast Reconstr Surg. 2008;122(3):833–9.

    CAS  Article  Google Scholar 

  5. 5.

    Su HH, Lui PW, Yu CL, et al. The effects of continuous axillary brachial plexus block with ropivacaine infusion on skin temperature and survival of crushed fingers after microsurgical replantation. Chang Gung Med J. 2005;28(8):567–74.

    PubMed  Google Scholar 

  6. 6.

    Niazi AU, El-Beheiry H, Ramlogan R, et al. Continuous infraclavicular brachial plexus blockade: effect on survival of replanted digits. Hand Surg. 2013;18(3):325–30.

    Article  Google Scholar 

  7. 7.

    Yu H, Wei L, Liang B, et al. Nonsurgical factors of digital replantation and survival rate: a metaanalysis. Indian J Orthop. 2015;49(3):265–71.

    Article  Google Scholar 

  8. 8.

    Shaterian A, Rajaii R, Kanack M, et al. Predictors of digit survival following replantation: quantitative review and meta-analysis. J Hand Microsurg. 2018;10(2):66–73.

    Article  Google Scholar 

  9. 9.

    Zhu X, Zhu H, Zhang C, et al. Pre-operative predictive factors for the survival of replanted digits. Int Orthop. 2017;41(8):1623–6.

    Article  Google Scholar 

  10. 10.

    Dec W. A meta-analysis of success rates for digit replantation. Tech Hand Up Extrem Surg. 2006;10(3):124–9.

    Article  Google Scholar 

  11. 11.

    Kurt E, Ozturk S, Isik S, et al. Continuous brachial plexus blockade for digital replantations and toe-to-hand transfers. Ann Plast Surg. 2005;54(1):24–7.

    CAS  Article  Google Scholar 

  12. 12.

    Fang XH. Regional anesthesia for microsurgery in China: a review. Reg Anesth. 1989;14(2):55–7.

    CAS  PubMed  Google Scholar 

  13. 13.

    Woo SH, Kim YW, Cheon HJ, et al. Management of complications relating to finger amputation and replantation. Hand Clin. 2015;31(2):319–38.

    Article  Google Scholar 

  14. 14.

    Kim WK, Lim JH, Han SK. Fingertip replantations: clinical evaluation of 135 digits. Plast Reconstr Surg. 1996;98(3):470–6.

    CAS  Article  Google Scholar 

  15. 15.

    Ozer K, Kramer W, Gillani S, et al. Replantation versus revision of amputated fingers in patients air-transported to a level 1 trauma center. J Hand Surg Am. 2010;35(6):936–40.

    Article  Google Scholar 

  16. 16.

    Yamano Y. Replantation of the amputated distal part of the fingers. J Hand Surg Am. 1985;10(2):211–8.

    CAS  Article  Google Scholar 

  17. 17.

    Patradul A, Ngarmukos C, Parkpian V. Distal digital replantations and revascularizations: 237 digits in 192 patients. J Hand Surg Br. 1998;23(5):578–82.

    CAS  Article  Google Scholar 

  18. 18.

    Soucacos PN, Beris AE, Touliatos AS, et al. Complete versus incomplete nonviable amputations of the thumb: comparison of the survival rate and functional results. Acta Orthop Scand Suppl. 1995;264:16–8.

    CAS  Article  Google Scholar 

  19. 19.

    Prucz RB, Friedrich JB. Upper extremity replantation: current concepts. Plast Reconstr Surg. 2014;133(2):333–42.

    CAS  Article  Google Scholar 

  20. 20.

    Sebastin SJ, Chung KC. A systematic review of the outcomes of replantation of distal digital amputation. Plast Reconstr Surg. 2011;128(3):723–37.

    CAS  Article  Google Scholar 

  21. 21.

    Burton AC, Yamada S. Relation between blood pressure and flow in the human forearm. J Appl Physiol. 1951;4(5):329–39.

    CAS  Article  Google Scholar 

  22. 22.

    Phelps DB, Rutherford RB, Boswick JA Jr. Control of vasospasm following trauma and microvascular surgery. J Hand Surg Am. 1979;4(2):109–17.

    CAS  Article  Google Scholar 

  23. 23.

    Kamarul T, Mansor A, Robson N, et al. Replantation and revascularization of amputated upper limb appendages outcome and predicting the factors influencing the success rates of these procedures in a tertiary hospital: an 8-year retrospective, cross-sectional study. J Orthop Surg (Hong Kong). 2018;26(1):230949901774998.

    Article  Google Scholar 

  24. 24.

    Lima JQ Jr, Carli AD, Nakamoto HA, et al. Prognostic factors on survival rate of fingers replantation. Acta Ortop Bras. 2015;23(1):16–8.

    Article  Google Scholar 

  25. 25.

    Tang JB, Wang ZT, Chen J, et al. A global view of digital replantation and revascularization. Clin Plast Surg. 2017;44(2):189–209.

    Article  Google Scholar 

  26. 26.

    Kim KS, Eo SR, Kim DY, et al. A new strategy of fingertip reattachment: sequential use of microsurgical technique and pocketing of composite graft. Plast Reconstr Surg. 2001;107(1):73–9.

    CAS  Article  Google Scholar 

  27. 27.

    Şirvan SS, Akgün Demir I, Irmak F, et al. Comparison of venous repair results using either arterial or vein grafts in a crush-avulsion injury model. Turk J Med Sci. 2019;49(1):435–41.

    Article  Google Scholar 

  28. 28.

    Efanov J, Khriguian J, Cassier S, et al. Duration and cessation characteristics of heparinization after finger replantation: a retrospective analysis of outcomes. Microsurgery. 2018;38(3):251–8.

    Article  Google Scholar 

  29. 29.

    Chen YC, Chi CC, Chan FC, et al. Low molecular weight heparin for prevention of microvascular occlusion in digital replantation. Cochrane Database Syst Rev. 2013;8(7):CD009894.

    Google Scholar 

  30. 30.

    Acree LS, Montgomery PS, Gardner AW. The influence of obesity on arterial compliance in adult men and women. Vasc Med. 2007;12(3):183–8.

    Article  Google Scholar 

  31. 31.

    Choi KM, Lee KW, Seo JA, et al. Relationship between brachial–ankle pulse wave velocity and cardiovascular risk factors of the metabolic syndrome. Diabetes Res Clin Pract. 2004;66(1):57–61.

    CAS  Article  Google Scholar 

  32. 32.

    Ross R. Atherosclerosis—an inflammatory disease. N Engl J Med. 1999;340(2):115–26.

    CAS  Article  Google Scholar 

  33. 33.

    Zhong-Wei C, Meyer VE, Kleinert HE, Beasley RW. Present indications and contraindications for replantation as reflected by long-term functional results. Orthop Clin N Am. 1981;12(4):849–70.

    CAS  Google Scholar 

  34. 34.

    Baker GL, Kleinert JM. Digit replantation in infants and young children: determinants of survival. Plast Reconstr Surg. 1994;94(1):139–45.

    CAS  Article  Google Scholar 

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Acknowledgements

The authors would like to thank Javier Martínez Cabañero and Cristian Hernández Delgado for their help with data collection.

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors and there is no conflict of interest.

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Correspondence to Ana Tejedor Navarro.

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Ana Tejedor, Marina Vendrell and Carlos Puente declare that they have no conflict of interest. This manuscript, including related data, figures and tables has not been previously published and is not under consideration elsewhere. I attest to the fact that all authors listed on the title page have read the manuscript, attest to the validity and legitimacy of the data and its interpretation, and agree to its submission to Injury. I acknowledge that both I and the other authors have read the Instructions for Authors and agree with its contents. I acknowledge that if the enclosed manuscript is part of a larger whole or if the primary analysis has been previously published, this must be explicitly stated in the manuscript and the previous publication cited.

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Tejedor Navarro, A., Vendrell Jordà, M. & Puente Alonso, C. Digital replantation/revascularization: predictive factors to microsurgery success—a single-center study. Eur J Trauma Emerg Surg 47, 225–232 (2021). https://doi.org/10.1007/s00068-019-01226-x

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Keywords

  • Amputation
  • Replantation
  • Revascularization
  • Digit
  • Survival rate