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Bueno A, Nevado-Sanchez E, Collazo C, De la Fuente-Anuncibay R, González-Bernal J. Functional Outcomes in Upper Limb Replantation-A Systematic Review. J Clin Med 2024; 13:1289. [PMID: 38592128 PMCID: PMC10931822 DOI: 10.3390/jcm13051289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 01/11/2024] [Accepted: 02/19/2024] [Indexed: 04/10/2024] Open
Abstract
Functionality after upper limb replantation is a decisive factor when considering the success of the intervention. Therefore, its evaluation is fundamental. The aim of this article was to conduct a systematic review of upper limb functions after replantation or reimplantation, seeking to identify reported functional outcomes as well as the level and mechanism of injury. To achieve this objective, a literature search was conducted in PubMed, ScienceDirect, Cochrane and Web of Science. Studies from the last 10 years which included patients with upper limb replantation and reported their functional outcomes were included. Out of 523 articles, 12 studies (n = 607) were finally included. DASH and CISS were the most commonly used assessments to report functional outcomes. In conclusion, functional outcomes after replantation are assessed using widely varying scales; therefore, due to this methodological variability, it is difficult to compare functional success between studies and further studies on functionality are needed to provide new data.
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Affiliation(s)
- Andrea Bueno
- Las Huelgas Health Centre (Burgos), 09001 Burgos, Spain;
| | - Endika Nevado-Sanchez
- Reconstructive and Aesthetic Plastic Surgery Service, Burgos University Hospital, 09006 Burgos, Spain;
| | - Carla Collazo
- Health Sciences Department, University of Burgos, 09006 Burgos, Spain;
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Tuaño KR, McCarty JC, Fisher MH, Eberlin KR. Outcomes following replantation surgery. Eur J Orthop Surg Traumatol 2023:10.1007/s00590-023-03729-1. [PMID: 37755559 DOI: 10.1007/s00590-023-03729-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 09/04/2023] [Indexed: 09/28/2023]
Abstract
The ability to perform surgical replantation of individual digits and limbs can provide substantial functional improvement for patients who sustain devastating upper extremity injuries. Defining success in replantation surgery extends beyond the acute period and the binary metrics of survival or loss of the replanted part to include the long-term overall functional outcomes. Functional outcomes include both objective clinical evaluation and patient-reported outcomes. There has been significant variation in the way outcomes following replantation are measured, which inherently leads to heterogeneity in the reported outcome data. Given the variability among outcome measures, we aim to explore the outcomes of replantation surgery, particularly clinical evaluation and patient-reported functional outcomes following replantation.
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Affiliation(s)
- Krystle R Tuaño
- Division of Plastic and Reconstructive Surgery, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA
| | - Justin C McCarty
- Division of Plastic and Reconstructive Surgery, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA
| | - Marlie H Fisher
- Division of Plastic and Reconstructive Surgery, University of Colorado Hospital, Denver, CO, 80045, USA
| | - Kyle R Eberlin
- Division of Plastic and Reconstructive Surgery, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA.
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Chang TNJ, Hsu CC, Dafydd H, Sachanandani NS, Chen LWY, Chen YC, Lin YT, Lin CH, Lin CH. Heterotopic Digital Replantation in Mutilating Hand Injuries: An Algorithmic Approach Based on 53 Cases and Literature Review. J Reconstr Microsurg 2023; 39:573-580. [PMID: 36720252 PMCID: PMC10411093 DOI: 10.1055/s-0043-1761288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 08/14/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND Reconstruction of the mutilated hand is one of the most difficult challenges for hand microsurgeons. When multiple digits are amputated, orthotopic digital replantation of the available remnants may not adequately restore the hand function. In such cases, heterotopic digital replantation may provide a more functional reconstruction. METHODS Between 1997 and 2018, 53 patients with mutilating hand injuries were treated with heterotopic digital replantation at our institution. A retrospective chart review was conducted to determine the details of the injury, indications for heterotopic digital replantation, and functional outcomes. RESULTS In total, 173 digits were amputated from 53 patients (one patient suffered from bilateral hand injuries, so totally 54 hands). Sixty-eight digits underwent heterotopic digital replantation, 30 digits had orthotopic digital replantation, and 75 stumps were terminalized. The survival rate of digits treated by heterotopic digital replantation and orthotopic digital replantation was 83.8% (57/68) and 86.7% (26/30), respectively (p = 1). Tripod grip was achieved in 83.3% (45/54) of patients following replantation and optional secondary reconstructive surgeries. CONCLUSION Heterotopic digital replantation is a practical and reliable method for achieving optimal hand function following mutilating hand injuries. The basic principles are to restore a functional thumb in the first instance, followed by at least two adjacent fingers against which the thumb can oppose. This method is particularly indicated when orthotopic digital replantation of the available amputated parts would yield a suboptimal result.
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Affiliation(s)
- Tommy Nai-Jen Chang
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Chang Gung Medical College and Chang Gung University, Taoyuan, Taiwan
| | - Chung-Chen Hsu
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Chang Gung Medical College and Chang Gung University, Taoyuan, Taiwan
| | - Hywel Dafydd
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Chang Gung Medical College and Chang Gung University, Taoyuan, Taiwan
| | - Neil S. Sachanandani
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Chang Gung Medical College and Chang Gung University, Taoyuan, Taiwan
| | - Lisa Wen-Yu Chen
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Chang Gung Medical College and Chang Gung University, Taoyuan, Taiwan
| | - Yi-Chieh Chen
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Chang Gung Medical College and Chang Gung University, Taoyuan, Taiwan
| | - Yu-Te Lin
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Chang Gung Medical College and Chang Gung University, Taoyuan, Taiwan
| | - Chih-Hung Lin
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Chang Gung Medical College and Chang Gung University, Taoyuan, Taiwan
| | - Cheng-Hung Lin
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Chang Gung Medical College and Chang Gung University, Taoyuan, Taiwan
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Bregman D, Nicholson L. Indications for replantation and factors that predict success. Eur J Orthop Surg Traumatol 2023:10.1007/s00590-023-03671-2. [PMID: 37596464 DOI: 10.1007/s00590-023-03671-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/24/2023] [Accepted: 08/02/2023] [Indexed: 08/20/2023]
Abstract
Since the advent of replantation techniques, there has been uneven progress in terms of success-even considering whether success is defined as continued perfusion of the digit or long term functional outcomes. Early enthusiasm and success have not been maintained despite increasing familiarity with microsurgical techniques and greater understanding of how to optimize outcomes for the individual components of replantation such as tendon repair, nerve repair, and osteosynthesis. Practitioners participating in the care of patients undergoing replantation should be familiar with the history and current understanding of both the indications and contraindications for the procedure, post-operative rehabilitation, and factors contributing to functional outcomes. A review of the literature from the first publications on the topic demonstrates evolution in practice and understanding of which patients should be indicated for replantation. Indications can be considered in three broad categories: injury factors, patient factors, and care context factors. These factors intersect with one another and can inform the surgeon pre-operatively regarding the most likely outcome for a given patient. This insight is critical to discuss pre-operatively with the patient in order to make a shared decision about how to manage their injury.
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Affiliation(s)
- Dana Bregman
- Department of Orthopedics, University of Southern California, Los Angeles, California, USA.
| | - Luke Nicholson
- Department of Orthopedics, University of Southern California, Los Angeles, California, USA
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Rosberg HE, Dahlin LB, Carlsson IK. A qualitative study of the long-term consequences and adaptation in daily life after replantation surgery at a young age. Hand Ther 2022; 27:112-122. [PMID: 37904897 PMCID: PMC10584065 DOI: 10.1177/17589983221118399] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 07/19/2022] [Indexed: 11/01/2023]
Abstract
Introduction Impaired functioning is seen in patients following replantation surgery to the thumb or fingers. Our aim was to explore long-term consequences and adaptation in daily life after a thumb and/or multiple finger amputation followed by replantation surgery during young age. Methods Semi-structured interviews were conducted with nine recruited individuals and analysed using content analysis. The participants were asked to describe their hand function, pain, appearance, emotional consequences, impact on daily life and strategies for overcoming daily challenges. Results The interviews revealed five main categories: memories of the injury and concerns for the future; hand function, pain and cold sensitivity; feelings about having a visibly different hand; adaptation to impairments and challenges in daily life; and key messages to healthcare professions and advice to future patients.The circumstances of the injury were well remembered. Pain at rest was rare but occurred when grasping. Cold sensitivity was a major issue. Appearance-related concerns varied from none to a major problem. Despite impaired hand function, solutions were found to challenges in daily life. Compensatory strategies, personal resources and support from others were important in this adaptation process. Conclusions Patients with replantation surgery after an amputation during young age adapt to challenges in daily life over time. Healthcare professionals should offer adequate support to enable emotional processing of trauma experience. Appearance-related concerns should be addressed to prevent distress. Information about alleviating strategies to overcome long-term problems with cold sensitivity should be emphasized.
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Affiliation(s)
- Hans-Eric Rosberg
- Department of Translational Medicine – Hand Surgery, Lund University, Malmö, Sweden
| | - Lars B Dahlin
- Department of Translational Medicine – Hand Surgery, Lund University, Malmö, Sweden
| | - Ingela K Carlsson
- Department of Translational Medicine – Hand Surgery, Lund University, Malmö, Sweden
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Li AT, Shepherd A, Gray SJ, Slattery P, Bruscino-Raiola F. Comparative outcome analysis of osseointegrated reconstruction and replantation for digital amputations. J Hand Surg Eur Vol 2022; 47:453-460. [PMID: 34278813 DOI: 10.1177/17531934211030752] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The long-term outcomes of osseointegration for digital amputations are not well established, and it is not known whether osseointegration can achieve similar function and patient satisfaction to conventional surgical options such as replantation and microsurgical toe transfer. We compared the long-term outcomes after digital osseointegration and replantation. Six patients treated by osseointegration and seven patients treated by replantation were included, with median follow-ups of 8 years and 4.6 years, respectively. Outcomes were assessed using the Michigan Hand Outcomes Questionnaire, grip and pinch strength, range of motion, two-point discrimination, Semmes-Weinstein tests, Jebsen-Taylor Hand Function Test and clinical photography. Osseointegration was associated with poorer sensibility and range of motion than replantation; no other differences reached statistical significance. Long-term osseointegration is a safe and effective reconstructive option that can deliver excellent outcomes in appropriately selected patients.Level of evidence: IV.
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Affiliation(s)
- Andrew T Li
- E.J. Anstee Research Group, Department of Plastic, Hand and Faciomaxillary Surgery, The Alfred Hospital, Melbourne, Victoria, Australia.,Advanced Surgical Amputee Programme, The Alfred Hospital, Melbourne, Victoria, Australia
| | - Angela Shepherd
- Department of Occupational Therapy, The Alfred Hospital, Melbourne, Victoria, Australia
| | - Steven J Gray
- E.J. Anstee Research Group, Department of Plastic, Hand and Faciomaxillary Surgery, The Alfred Hospital, Melbourne, Victoria, Australia.,Advanced Surgical Amputee Programme, The Alfred Hospital, Melbourne, Victoria, Australia
| | - Philip Slattery
- E.J. Anstee Research Group, Department of Plastic, Hand and Faciomaxillary Surgery, The Alfred Hospital, Melbourne, Victoria, Australia.,Advanced Surgical Amputee Programme, The Alfred Hospital, Melbourne, Victoria, Australia
| | - Frank Bruscino-Raiola
- E.J. Anstee Research Group, Department of Plastic, Hand and Faciomaxillary Surgery, The Alfred Hospital, Melbourne, Victoria, Australia.,Advanced Surgical Amputee Programme, The Alfred Hospital, Melbourne, Victoria, Australia
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Bharathi R, Bhardwaj P, Varadharajan V, Venkatramani H, Sabapathy SR. A Unique Case of Replantation of Previously Replanted Fingers. Indian J Plast Surg 2021; 54:86-89. [PMID: 33814748 PMCID: PMC8012787 DOI: 10.1055/s-0041-1723911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Replantation of digital amputations is now the accepted standard of care. However, rarely will a replantation surgeon be presented with amputated fingers which have been previously replanted. In our literature search, we could find only one publication where a replanted thumb suffered amputation and was successfully replanted again. We report the technical challenges and the outcome of replanting two fingers which suffered amputation 40 months after the initial replantation and were successfully replanted again. Replantation was critical since the amputated fingers were the only two complete fingers in that hand which had initially suffered a four-finger amputation. The second-time replantation of previously replanted fingers is reported to allay the concern of the reconstructive surgeon when faced with this unique situation of “repeat amputation of the replanted finger.” Second-time replantation is feasible and is associated with high-patient satisfaction. Replantation must be attempted especially in the event of multiple digit amputations.
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Affiliation(s)
- Ravindra Bharathi
- Department of Plastic, Hand, Burns and Reconstructive Microsurgery, Ganga Hospital, Coimbatore, Tamil Nadu, India
| | - Praveen Bhardwaj
- Department of Plastic, Hand, Burns and Reconstructive Microsurgery, Ganga Hospital, Coimbatore, Tamil Nadu, India
| | - Vigneswaran Varadharajan
- Department of Plastic, Hand, Burns and Reconstructive Microsurgery, Ganga Hospital, Coimbatore, Tamil Nadu, India
| | - Hari Venkatramani
- Department of Plastic, Hand, Burns and Reconstructive Microsurgery, Ganga Hospital, Coimbatore, Tamil Nadu, India
| | - S Raja Sabapathy
- Department of Plastic, Hand, Burns and Reconstructive Microsurgery, Ganga Hospital, Coimbatore, Tamil Nadu, India
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Abstract
Background: Digit replantation affords the opportunity to restore hand function following amputation. To date, however, few studies have evaluated functional outcomes following replantation. Therefore, it was the objective of this study to perform a meta-analysis to better characterize the predictors of hand function. Methods: A literature search was performed using the PubMed database to identify studies that focused on digit amputation/replantation and functional outcomes. Studies were evaluated for patient- and injury-related factors and their respective effects on clinical outcomes of sensation, grip strength, and Disabilities of the Arm, Shoulder, and Hand (DASH) scores. Statistical analysis was conducted across the pooled data set to identify significant trends. Results: Twenty-eight studies representing 618 replanted digits were included in this study. We found the average grip strength was 78.7% (relative to contralateral), the average 2-point discrimination (2PD) was 7.8 mm, and the average DASH score was 12.81. After conducting statistical analysis, we found patients with more proximal injuries had lower grip strength scores (P < .05). We found 2PD scores were influenced by age, mechanism of injury, and amputation level (P < .05). Finally, we found DASH scores after replantation were predicted by mechanism of injury and level of amputation (P < .05). The following variables did not influence outcomes: gender, tobacco use, ischemia time, and digit number. Conclusions: Digit replant does not restore premorbid hand function but does result in adequate hand function. Expected functional outcomes following replant should be considered in the decision-making process. These data can help risk-stratify patients, guide postreplant expectations, and influence the decision for replantation.
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Affiliation(s)
| | | | | | - Daniel J. Gardner
- University of California, Irvine,
Orange, USA,Daniel J. Gardner, Department of Plastic
Surgery, University of California, Irvine, 200 South Manchester Avenue, Suite
650, Orange, CA 92868, USA.
| | | | - Amber Leis
- University of California, Irvine,
Orange, USA
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Moltaji S, Gallo M, Wong C, Murphy J, Gallo L, Waltho D, Copeland A, Karpinski M, Mowakket S, Duku E, Thoma A. Reporting Outcomes and Outcome Measures in Digital Replantation: A Systematic Review. J Hand Microsurg 2020; 12:85-94. [PMID: 33335363 DOI: 10.1055/s-0040-1701324] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Introduction There is a lack of consensus on what the critical outcomes in replantation are and how best to measure them. This review aims to identify all reported outcomes and respective outcome measures used in digital replantation. Materials and Methods Randomized controlled trials, cohort studies, and single-arm observational studies of adults undergoing replantation with at least one well-described outcome or outcome measure were identified. Primary outcomes were classified into six domains, and outcome measures were classified into eight domains. The clinimetric properties were identified and reported. A total of 56 observational studies met the inclusion criteria. Results In total, 29 continuous and 29 categorical outcomes were identified, and 87 scales and instruments were identified. The most frequently used outcomes were survival of replanted digit, sensation, and time in hospital. Outcomes and measures were most variable in domains of viability, quality of life, and motor function. Only eight measures used across these domains were validated and proven reliable. Conclusion Lack of consensus creates an obstacle to reporting, understanding, and comparing the effectiveness of various replantation strategies.
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Affiliation(s)
- Syena Moltaji
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Matteo Gallo
- Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Chloe Wong
- Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Jessica Murphy
- Division of Plastic Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Lucas Gallo
- Division of Plastic Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Daniel Waltho
- Division of Plastic Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Andrea Copeland
- Division of Plastic Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Marta Karpinski
- Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Sadek Mowakket
- Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Eric Duku
- Department of Psychiatry and Behavioral Neurosciences, McMaster University, Hamilton, Ontario, Canada
| | - Achilleas Thoma
- Division of Plastic Surgery, McMaster University, Hamilton, Ontario, Canada.,Department of Surgery, McMaster University, Hamilton, Ontario, Canada.,Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
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10
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Abstract
The variability in reported outcomes and outcome measures used in digit replantation makes it difficult to compare results among studies. This article reviews the principles of measuring functional and patient-reported outcomes after replantation, and describes the recommended instruments to use and ways to report results.
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Affiliation(s)
- Hoyune E. Cho
- T32 Postdoctoral Research Fellow, Section of Plastic Surgery, Department of Surgery, University of Michigan Medical School, Ann Arbor, MI
| | - Sandra V. Kotsis
- Research Coordinator, Section of Plastic Surgery, Department of Surgery, University of Michigan Medical School, Ann Arbor, MI
| | - Kevin C. Chung
- Professor of Surgery, Chief of Hand Surgery, Section of Plastic Surgery, Department of Surgery, Michigan Medicine, Ann Arbor, MI
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Chen J, Zhang AX, Chen QZ, Mu S, Tan J. Long-term functional, subjective and psychological results after single digit replantation. Acta Orthop Traumatol Turc 2018; 52:120-126. [PMID: 29454562 PMCID: PMC6136331 DOI: 10.1016/j.aott.2017.09.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/24/2016] [Revised: 09/02/2017] [Accepted: 09/06/2017] [Indexed: 01/09/2023]
Abstract
Objective The aim of this study was to analyse the long-term functional, subjective, and psychological results after single-digit replantation. Methods Thirty cases of digital replantation (14 thumbs, 12 index fingers, 2 middle fingers, 1 ring finger, and 1 little finger) in 30 patients (7 females and 23 males) with a mean age of 44.2 years (20–65 years) were evaluated at the end of a mean follow-up time of 36 months (19–50 months). The active range of motion of joints, grip and pinch strength, cutaneous sensibility, upper-extremity functioning, and subjective satisfaction were determined using the Disability of Arm, Shoulder, and Hand (DASH) questionnaire and the Michigan Hand Outcomes questionnaire (MHQ). Psychological sequelae, including depression, anxiety, and posttraumatic stress disorder (PTSD), were assessed. A correlation analysis among variables was also performed. Results The mean score for the DASH questionnaire was 6.6 (range: 0–39.2). The symptom of cold intolerance occurred in 53% of the patients. Two patients were diagnosed with depression, and only one patient exhibited PTSD. The DASH score had a good statistical correlation with total grip strength, pinch grip strength, and static two-point discrimination (S-2PD) (P < 0.05). Several aspects of the MHQ were also statistically relevant to some or all of the three objective results. Furthermore, the grip strength showed significant correlation with DASH and most aspects of the MHQ in multivariate logistic regression analysis (P < 0.05). Conclusion Total grip strength is the most important factor positively related to subjective outcomes. The incidence rates of psychological symptoms after digit replantation are very low at long-term follow-up. Level of evidence Level IV, therapeutic study.
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Abstract
BACKGROUND Ring avulsion injuries can range from soft tissue injury to complete amputation. Grading systems have been developed to guide treatment, but there is controversy with high-grade injuries. Traditionally, advanced ring injuries have been treated with completion amputation, but there is evidence that severe ring injuries can be salvaged. The purpose of this systematic review was to pool the current published data on ring injuries. METHODS A systematic review of the English literature published from 1980 to 2015 in PubMed and MEDLINE databases was conducted to identify patients who underwent treatment for ring avulsion injuries. RESULTS Twenty studies of ring avulsion injuries met the inclusion criteria. There were a total of 572 patients reported with ring avulsion injuries. The Urbaniak class breakdown was class I (54 patients), class II (204 patients), and class III (314 patients). The average total arc of motion (TAM) for patients with a class I injury was 201.25 (n = 40). The average 2-point discrimination was 5.6 (n = 10). The average TAM for patients with a class II injury undergoing microsurgical revascularization was 187.0 (n = 114), and the average 2-point discrimination was 8.3 (n = 40). The average TAM for patients with a class III injury undergoing microsurgical revascularization was 168.2 (n = 170), and the average 2-point discrimination was 10.5 (n = 97). CONCLUSIONS Ring avulsion injuries are commonly classified with the Urbaniak class system. Outcomes are superior for class I and II injuries, and there are select class III injuries that can be treated with replantation. Shared decision making with patients is imperative to determine whether replantation is appropriate.
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Affiliation(s)
- Ravinder Bamba
- Vanderbilt University, Nashville, TN, USA,Georgetown University, Washington, DC, USA,Ravinder Bamba, Department of Plastic Surgery, Vanderbilt University Medical Center, Vanderbilt University, 1121 21st Avenue S, S-2221, Nashville, TN 37232-2345, USA.
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13
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Abstract
There are multiple surgical techniques to stabilize the bone in digital replantation. Various criteria need to be considered when choosing appropriate bony fixation including operative time, ease of exposure, stability, limitation of the area of dissection, and reproducibility. We describe our technique using internal fixation with a low-profile plate on the palmar aspect of the proximal or middle phalanx during replantation of a digit. This technique allows coverage of the plate with no risk of compromising the dorsal venous anastomosis. In our experience, using this technique we have observed no complications including no secondary displacement of the fragments or extensor tendon rupture and no incidence of infection. In addition, this technique allows adequate bony fixation to enable an early active range of motion rehabilitation program.
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