Case control study of modified and traditional treatment after digit replantation in a single center with large sample

Abstract

Objective To compare the survival rate, incidence of vascular crisis, adverse drug reactions and average in-hospital time of the traditional and modified treatment groups after digit replantation. Methods From January 2015 to January 2016, 923 cases (1 225 fingers) of digit replantation were treated with modified postoperative protocol. Only papaverine (72 hours), low molecular heparin (5 days) and prophylactic antibiotics (72 hours) were used. Fluid was replenished with crystal only, except for patients with serious blood loss, who might need concentrated red blood cell or cryofresh plasma. The patients were advised to stay in bed for absolutely 3 days. From January 2012 to January 2013, 785 cases (915 fingers) of digit replantation were treated with traditional protocol, in addition to the use of papaverine and low molecular heparin, including low molecular dextran or hydroxyethyl starch and anisodamine hydrochloride. After operation the patients were advised to stay in bed for absolutely 7 days. The results of the two groups were compared statistically including the survival rate, incidence of vascular crisis, adverse drug reactions and average in-hospital time. Results The survival rate of digit replantation was 92.13% in traditional group and 92.07% in modified group. There was no statistical difference between the two groups. Similarly, the incidence of vascular crisis was 14.09% in traditional group and 15.18% in modified group. There was no statistical difference between the two groups. However, the incidence of adverse drug reactions was 15.7% in traditional group and 2.2% in modified group. There was a significant difference between the two groups (P<0.01). The average in-hospital time was (10.23±3.21) days in traditional group and (8.34±2.75) days in modified group. The difference between the two groups was statistically significant (P<0.05). Conclusion The modified postoperative protocol for digit replantation can shorten the in-hospital time, reduce the medicine related complications, and had no effect on the survival rate of digit replantation. Thus it is worthy of clinical promotion. Key words: Replantation; Case-control studies; Treatment protocol; Anticoagulation