A 17-Year Experience in Hand and Digit Replantation at an Academic Center
| Autor: | Alicia Billington, Jason Nydick, R. Maxwell Rotatori, Ryan L. Kim, Benjamin W. Ogden, Nicole K. Le, Kathryn S. King |
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| Rok vydání: | 2021 |
| Předmět: |
Adult
medicine.medical_specialty Adolescent medicine.medical_treatment Thumb Logistic regression Avulsion Fingers Young Adult Amputation Traumatic medicine Humans Survival rate Retrospective Studies Academic Medical Centers business.industry Trauma center Graft Survival Hand Injuries Middle Aged Hand Numerical digit Surgery medicine.anatomical_structure Treatment Outcome Mechanism of injury Replantation business Follow-Up Studies |
| Zdroj: | Plastic and reconstructive surgery. 148(4) |
| ISSN: | 1529-4242 |
| Popis: | 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. |
| Databáze: | OpenAIRE |
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