Clinical outcomes of salvage revision surgery following finger replantation with vascular insufficiency: A retrospective study
| Autor: | Özgün Barış Güntürk, Murat Kayalar, Tulgar Toros, Yusuf Gürbüz, Ulaş Bali, Kemal Ozaksar |
|---|---|
| Jazyk: | angličtina |
| Rok vydání: | 2020 |
| Předmět: |
Adult
Male Reoperation medicine.medical_specialty medicine.medical_treatment Time-to-Treatment Fingers Avulsion 03 medical and health sciences Postoperative Complications 0302 clinical medicine Amputation Traumatic lcsh:Orthopedic surgery Ischemia Finger Injuries medicine Humans Orthopedics and Sports Medicine Vein Survival rate Retrospective Studies Salvage Therapy 030222 orthopedics business.industry Lunula Retrospective cohort study 030229 sport sciences General Medicine Phalanx Surgery body regions lcsh:RD701-811 Outcome and Process Assessment Health Care medicine.anatomical_structure Amputation Replantation Female business Vascular Surgical Procedures Research Article |
| Zdroj: | Acta Orthopaedica et Traumatologica Turcica, Vol 54, Iss 6, Pp 577-582 (2020) Acta Orthop Traumatol Turc |
| Popis: | Objective The aim of this study was to analyze the outcomes of revision surgery following replantation of single digital amputations. Methods In this study, first, a total of 403 patients (339 male, 64 female; mean age=28 years; age range=1-76) in whom a single finger replantation was performed were retrospectively reviewed, and then 60 patients with arterial or venous insufficiency in whom revision surgery was performed were reanalyzed. The second finger was observed to be the most injured one (32.8%). Injury type was classified as clean cut (25.3%), local crush (38.7), extensive crush (7.9%), and avulsion (28.1%). When taking the levels of injuries of the artery-only finger replantations into account, one finger (0.8%) was nail distal third, 70 fingers (56%) were nail distal third to lunula, 43 fingers (34.4%) were lunula to distal phalanx basis, 10 fingers (8%) were distal interphalangeal (DIP) joint, and one finger (0.8%) was middle phalanx. Operative revision was performed on 60 (14.9%) fingers. The need for operative revision was arterial insufficiency in 37 fingers (61.7%) and venous insufficiency in 23 fingers (38.3%). The average revision time was 43 (range=6-144) hours. While the average elapsed time for artery procedures was 35.3 (range=8-110) hours, the average elapsed time for vein procedures was 47.1 (range=6-144) hours. Finger survival rates were examined. Injury mechanism, amputation level, the number of artery/vein repairs and methods were examined in all patients and revision patients separately. Results After the replantations, according to survival analysis, while 342 (84.9%) fingers were operated upon successfully, 61 (15.1%) fingers developed necrosis. In the patients with revision surgery, the survival rate was 78.3%. The need for revision was arterial insufficiency in 37 fingers (61.7%) and venous insufficiency in 23 fingers (38.3%). The revision rate was significantly lower than other injury types in clean-cut cases. In terms of levels of injury, no revisions were required from distal to lunula level, and the highest revision rate was observed at the proximal interphalangeal (PIP) joint level. Conclusion The results of the present study have shown that early re-exploration can provide a 78.3% success rate and can increase the survival rate from 67.6% to 84.2% following replantation of single digital amputations. Surgical re-exploration seems to be a reasonable salvage for replanted fingers with vascular insufficiency. Level of evidence Level IV, Therapeutic study. |
| Databáze: | OpenAIRE |
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