Survival Rate Of Replantation Research Articles

Clinical study of 2230 distal finger replants

Replantation is an ideal technique for reconstruction following fingertip amputation as it provides 'like for like' total reconstruction of the nail complex, bone pulp tissue and skin with no donor-site morbidity. This study is a clinical research on distal finger replantation and its classification, the purpose is to get better understanding of the neurovascular anatomy of distal finger, guide the clinical work, and improve the survival rate of replantation. Thirty-six damaged fingers with intact distal parts dissections were studied, focusing attention on the classification of the distal finger replantation. We summarized that the distal finger replantation can be classified into three types, based on the level at which it was amputated. Type I, level between the crease of DIPJ and the nail root. Type II, level between the nail root and the fingerprint center. Type III, level distal to the fingerprint center. From Jan 1995 to Mar 2013, 2230 cases (2645 fingers) of distal finger replantations were performed in our hospital, including 1434 fingers of type I, 737 fingers of type II, 374 fingers of type III. The artery diameter of type I and II refers to 0.3 mm - 0.6 mm, the dorsal and volar vein diameter refers to 0.3 mm - 0.8 mm. The artery of type III is showing dendritic, the diameter refers to 0.1 mm - 0.3 mm, vein diameter refers to 0.15 mm - 0.3 mm. The surgery includes debriding the wound, locating and tagging the vessels and nerves, shortening and fixing the bone, anastomosing the arteries, repairing the nerves, anastomosing the veins, and closing the wound. In the replantation of type I amputations, we could always find 1-2 arteries, 2 or more veins and 2 digital nerves which should be anastomosed. In type II amputations, 1-2 arteries, 1-2 veins and 2 digital nerves could be anastomosed, and sometimes we used veno-arteriolization technique. In type III amputations, the artery was really tiny, and we usually could only find 1 artery, 1 vein and 2 nerves which should be anastomosed. And also, if the distal vein was difficult to find, we anastomosed the distal artery to proximal vein. The postoperative treatment was much the same with the other replantations with a simiilar rehabilitation procedure. The replantation survival rate of the three types was 97.7%, 95% and 97% respectively. Follow-up period was 9-24 months. All the surviving replanted fingers achieved good sensory recovery and a satisfactory appearance. Conclusion: The replantation of the distal finger needs skilled microsurgical techniques. The Classification is important to choose the technique of replantation. Different types of fingertip amputation need different techniques. The vascular anastomosis is performed under the surgical microscope at 10x magnification in type I and II, and 16x magnification in type III. The venous drainage is usually a key point of the replantation. More veins should be anastomosed if possible. Veno-arteriolization technique is an effective way if we can only find the proximal vein. If it is really difficult to find any vein in type III, a tiny incision at the replanted fingertip that is kept bleeding after surgery can help drainage.

Prognostic factors on survival rate of fingers replantation

Objective: To evaluate the factors that influence the survival rate of replantation and revascularization of the thumb and/or fingers. Methods: We included fifty cases treated in our department from May 2012 to October 2013 with total or partial finger amputations, which had blood perfusion deficit and underwent vascular anastomosis. The parameters evaluated were: age, gender, comorbidities, trauma, time and type of ischemia, mechanism, the injured area, number of anastomosed vessels and use of vein grafts. The results were statistically analyzed and type I error value was set at p <0.05 .Results: Fifty four percent of the 50 performed replantation survived. Of 15 revascularizations performed, the survival rate was 93.3%. The only factor that affected the survival of the amputated limb was the necessity of venous anastomosis. Conclusion: We could not establish contraindications or absolute indications for the replantation and revascularization of finger amputations in this study. Level of Evidence III, Retropective Study.

Related factors and clinical countermeasures of replantation operation survival

Objective To investigate the related factors on survival rate of digital replantation and clinical measures.Methods 27 patients with digital replantation were selected,patients'various aspects relevant factors on the survival rate of digital replantation were analyzed by the single factor analysis and multi-factor Logistic regression.Results 35 fingers were needed to be replanted,the successful rate was 85.7％.There were significant differences in survival rate based on different treatment after injury,different injury reason,use of the vein graft,duration of warm ischemia,whether thrombosis,whether vascular crisis between survival group and non-survival group (x2 =6.386,3.889,4.704,6.176,10.802,4.564,all P ＜ 0.05).The results of multivariate Logistic regression analysis showed that processing method after injury,injury reason,use of the vein graft,warm ischemia time,whether thrombosis,whether vascular crisis were the factors directly affected the survival rate (r =0.902,0.957,0.922,1.825,2.053,1.026,all P ＜ 0.05).Conclusion In order to improve the digital replantation survival rate,patients should be investigated and assessed before digital replantation.The indications should be reasonable selected,factors are compositely considered,preventive measures are taken timely. Key words: Digital replantation; Survive rate ; Factor analysis, Statistical

Effect of postoperative analgesia with dexmedetomidine on the survival rate of amputated finger replantation

To observe the effect of postoperative analgesia with dexmedetomidine on the survival rate of amputated finger replantation. 91 cases, who was going to receive amputated finger replantation, were randomly divided into group A (n = 48) and B (n = 43). PCIA (patient-controlled intravenous analgesia) was set immediately after operation in group A (fentanyl 1.0 mg + tropisetron 4.0 mg + 10 mg + dexmedetomidine 200 microg + saline 100 ml) and group B (same as group A except dexmedetomidine). Background infusion is 2 ml/h with a bolous of 0.5 ml and lockout time is 15 min. postoperative VAS score, Ramsay score, condition of replanted fingers and other adverse events at the 0-6 h, 6-12 h, 12-24 h and 24-48 h were recorded and analyzed. The age, sex, height, weight, amputated time (Ts), revascularized time (Tt) in the two groups were not statistically different (P > 0.05). Postoperative VAS score in the two groups was significantly different at the 0-6 h, 6-12 h, 12-24 h and 24-48 h (P < 0.05), but Ramsay score was not (P > 0.05). The highest and lowest postoperative VAS score and Ramsay score were markedly different between two groups (P < 0.05). 3 of the 60 fingers in group A experienced vascular crisis and 2 underwent vascular explore surgery. 13 of 56 fingers in group B occurred vascular crisis, and 10 underwent vascular explore surgery, showing significant difference between the two groups (P < 0.05). PCIA adverse reactions showed no difference between the two groups (P > 0.05). Bradycardia and hypotension didn't happen in any patients in the two groups. 4 weeks after surgery, the survival rate was 96.7% (58/60) in group A, and 83.9% (47/56) in group B (P < 0.05). Postoperative analgesia with dexmedetomidine as an adjuvant can increase the survival rate of replantation fingers with high safety.

A Clinical Study and Classification of Distal Fingers Replantation of 2230 Cases

Introduction: Replantation is an ideal technique for reconstruction following fingertip amputation as it provides ‘like for like’ total reconstruction of the nail complex, bone pulp tissue and skin with no donor-site morbidity. This study is a clinical research on distal finger replantation and its classification, the purpose is to improve the survival rate of replantation.

SECONDARY SURGERIES AFTER DIGITAL REPLANTATIONS: A CASE SERIES

We evaluated the injuries, survival rats, and secondary surgeries of patients who had undergone finger replantation or revascularization between October 2005 and July 2010. The 70 digits came from 43 patients (average age, 46 years; range, 19 to 78 years; 37 men). Overall replantation survival rate was 94%; 93% (27/29) for complete amputations and 95% (39/41) for near-amputations. In all, 39 digits from 21 patients required 48 secondary surgeries; skin grafts, tenolysis, joint fusion, bone graft, osteotomy, and web plasty. The more proximal or more severe the injuries, the higher the need of secondary surgeries. The most common surgery soon after replantation was skin coverage; the most common after two months was tendon surgery. Primary repair must be adequate to restore the function and appearance of amputated digits; however, the possible need for secondary surgeries must be kept in mind to avoid restricting the options for secondary procedures.

Primary Vein Grafting in Treatment of Ring Avulsion Injuries

Out of 262 hands with total finger amputations treated by replantation of finger/fingers from January 2001 until January 2006, there were only 6 cases of type III ring avulsion injuries, all of which were replanted. Radical resection of the damaged part of the artery with primary vein grafting was used in each case; only 1 artery and 2 veins were anastomosed for each finger. The survival rate was 100%. Mean total active motion was 195 degrees (ranging from 175 degrees to 220 degrees ). Mean 2-point discrimination was 8.6 mm static (ranging from 4 to 11 mm) and 6.2 mm moving (ranging from 3 to 9 mm), and mean grip strength was 37.4 kg. We believe that liberal resection of the "zone of contusion" of vessels and primary vein grafting for arterial repair can improve the overall survival rate of replantation in type III ring avulsion injuries, and replantation can be attempted in majority of the cases; good hand function can be expected.

飯塚病院における切断肢・指再接着の現況について

We reviewed 61 patients who had been treated between July 1990 and June 1999 for complete or incomplete amputation of limbs and digits with microvascular techniques. Their mean age was 40 years (3 to 72) and there were 53 males and 8 females. Amputated parts included 11 limbs and 66 digits. The survival rate of replantation was 72% (23 to 32 parts) in complete amputations and 93% (42 of 45 parts) in incomplete amputations. The overall survival rate was 84% (65 of 77 parts). The reason for the failure in 12 replantations is discussed.

Thumb replantation: Survival factors and re-exploration in 122 cases

We analyzed 122 cases of replantation following complete amputation of the thumb and correlated various factors with rates of survival. The overall survival rate of thumb replantation was 71%. The type of amputation markedly affected survival rate. In minimally damaged amputations, the time period from injury to the start of surgery was the only significant factor related to survival. Other factors such as age, smoking history, amputation level, the number of vessels reconstructed and the method used did not relate statistically to survival. With avulsion amputations, the survival rate of replantation at and proximal to the MP joint was significantly better than replantation distal to the MP joint. 20 thumbs required re-exploration for vascular compromise; nine of these were salvaged (45%).

Five year digital replantation series from the frigid zone of China

A series of 208 digital replantations from the frigid zone within the People's Republic of China is presented. The extremely cold climate (often -20 degrees C to -30 degrees C) presents the problem of warming exposed amputated digits prior to replantation without causing further damage. An overall replantation survival rate of 94% is reported, and this includes 45 cases of multiple digit amputation. Longer periods of ischemia seem to be tolerated under these unusually frigid conditions. Problems encountered within the series and suggestions for successful outcomes are discussed.

Current Procedures in China on Replantation of Severed Limbs and Digits

Since the first successful replantation of a severed right hand was reported in 1963, surgeons in China have performed more than 3735 replantations of limbs and digits with increasing improvement in the survival rate. Of special interest is that local hospitals have reported numerous successful cases revealing a popularization of this kind of operation in China. The replantation survival rate is related to the type of injury and duration of anoxia. The types of injury include avulsion or crush amputation, severed distal segments of fingers, immersion conditions, amputated limbs or digits in children, and segmental resection of diseased tissues. The results are analyzed by a special system of functional evaluation.