A 17-Year Experience in Hand and Digit Replantation at an Academic Center.

Autor:	Billington AR; From the Department of Plastic Surgery, Morsani College of Medicine, University of South Florida; Provo Hand, Wrist and Elbow Center, Revere Health; Department of Hand and Upper Extremity Surgery, Florida Orthopaedic Institute; and the Yale School of Public Health., Ogden BW; From the Department of Plastic Surgery, Morsani College of Medicine, University of South Florida; Provo Hand, Wrist and Elbow Center, Revere Health; Department of Hand and Upper Extremity Surgery, Florida Orthopaedic Institute; and the Yale School of Public Health., Le NK; From the Department of Plastic Surgery, Morsani College of Medicine, University of South Florida; Provo Hand, Wrist and Elbow Center, Revere Health; Department of Hand and Upper Extremity Surgery, Florida Orthopaedic Institute; and the Yale School of Public Health., King KS; From the Department of Plastic Surgery, Morsani College of Medicine, University of South Florida; Provo Hand, Wrist and Elbow Center, Revere Health; Department of Hand and Upper Extremity Surgery, Florida Orthopaedic Institute; and the Yale School of Public Health., Rotatori RM; From the Department of Plastic Surgery, Morsani College of Medicine, University of South Florida; Provo Hand, Wrist and Elbow Center, Revere Health; Department of Hand and Upper Extremity Surgery, Florida Orthopaedic Institute; and the Yale School of Public Health., Kim RL; From the Department of Plastic Surgery, Morsani College of Medicine, University of South Florida; Provo Hand, Wrist and Elbow Center, Revere Health; Department of Hand and Upper Extremity Surgery, Florida Orthopaedic Institute; and the Yale School of Public Health., Nydick J; From the Department of Plastic Surgery, Morsani College of Medicine, University of South Florida; Provo Hand, Wrist and Elbow Center, Revere Health; Department of Hand and Upper Extremity Surgery, Florida Orthopaedic Institute; and the Yale School of Public Health.
Jazyk:	angličtina
Zdroj:	Plastic and reconstructive surgery [Plast Reconstr Surg] 2021 Oct 01; Vol. 148 (4), pp. 816-824.
DOI:	10.1097/PRS.0000000000008314
Abstrakt:	Background Results: of replantation surgery following upper extremity traumatic amputation are extensively described in the literature, with success rates varying from 57 to 100 percent. The purpose of this study was to evaluate replantation success rate at a Level I trauma center over a 17-year period and to assess definable factors contributing to these results. Methods: A retrospective review of all digit and hand replantations at a Level I trauma center was performed using CPT codes from 2001 through 2018. Descriptive analyses, Mann-Whitney test, Kruskal-Wallis test, and logistic regressions were used. Significance was defined as p ≤ 0.05. Results: Analysis consisted of 76 patients with 101 amputated parts (93 digits and eight hands). Fifty-six single digit amputations (30 percent success rate), 37 multidigit injuries (22 percent digit success rate), and eight hand amputations (50 percent success rate) were attempted. The overall success rate was 25 of 76 patients (33 percent) and 29 of 101 parts (29 percent). The most common mechanism of injury was laceration (n = 56), followed by crush (n = 30), and avulsion (n = 11), with repair of laceration-type injuries having the greatest success rate (36 percent). Conclusions: The authors report a lower success rate of hand and digit replantation than previously described in the literature. Whole hand and thumb replantations resulted in the highest survival rate in our series. Laceration mechanism showed a higher success rate than crush or avulsion-type injuries. The authors' modest results highlight the importance of effective internal auditing of low-volume replantation centers such as their own. Quality improvement measures are proposed for higher future success in replantation surgery at the authors' institution. Clinical Question/level of Evidence: Therapeutic, IV. (Copyright © 2021 by the American Society of Plastic Surgeons.)
Databáze:	MEDLINE
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