Survival Rate Of Replantation Research Articles

The Effect of Modified Postoperative Treatment on Finger Replantation Survival Rate

Objective: To explore the clinical effect of modified treatment after finger replantation and its impact on the survival rate of replantation. Methods: The research was conducted from March 2022 to March 2023. A total of 58 patients who underwent finger replantation at our hospital were selected. These patients were divided into two groups using the digital table grouping method: the research group (n = 29) and the control group (n = 29). Patients in the control group received standard treatment following finger replantation, while patients in the study group received modified treatment after the procedure. The incidence of vascular crisis and the survival rate of replantation were compared between the two groups. Results: The incidence of vascular crisis in the study group was lower than that in the control group (P < 0.05); the replantation survival rate in the study group was higher than that in the control group (P < 0.05). Conclusion: Modified treatment after replantation of severed fingers can reduce the incidence of vascular crisis replantation and improve the survival rate of replantation, so it should be popularized and applied in medical institutions.

Investigation on the relationship between Eysenck personality type and the survival rate of traumatic amputated finger replantation based on preventive psychology

This paper tried to observe the relationship between the personality of patients with different personalities and the survival rate of replantation of traumatic amputated finger, and analyzed the influencing factors. EPQ psychological quality scores of patients with different gender, average monthly family income and age were significantly different (P < 0.05). In terms of the internal and external tendency score of EPQ, there were statistical requirements for differences in the mean monthly income of patients from different families (P < 0.05). For the concealment degree of EPQ, there were statistical requirements for differences in gender, family income, education level and patient scores (P < 0.05). In terms of mental state, the scores were higher than the standard, whether from the perspective of obsessive-compulsive symptoms, or from the perspective of interpersonal sensitivity, hostility, paranoia and other dimensions, the difference was statistically significant (P < 0.05). Patients with different personality types have different psychological problems after accidental amputation and replantation, which is directly related to the survival rate of postoperative finger amputation. Therefore, in order to effectively improve the survival rate of patients with finger amputation, the psychological condition of patients can be assessed, early detection and intervention of patients' psychological problems, and appropriate intervention measures can be taken according to the personality characteristics of patients.

Prognostic Factors for Attempted Finger Replantation and Revascularisation after Traumatic Amputation: A 16-Year Retrospective Cohort Study.

Background: The aim of this study was to evaluate the impact of variant factors on finger replantation and revascularisation after traumatic amputation, which also included duty shift and the level of main operator. Methods: To determine the prognostic factors for the survival rate of finger replantation and revascularisation after traumatic finger amputation, we retrospectively reviewed the cases of finger replantation conducted from January 2001 to December 2017. Data collected consisted of the basic information of the patients, trauma-related factors, details of the operation and treatment outcomes. Descriptive statistics and data analysis was performed to assess outcomes. Results: In total, 150 patients with 198 replanted digits were enrolled in this study. The median age of the participants was 42.5 years, and 132 (88%) patients were men. The overall successful replantation rate was 86.4%. Seventy-three (36.9%) digits had Yamano type 1 injury; 110 (55.6%), Yamano type 2 injury and 15 (7.6%), Yamano type 3 injury. In total, 73 (36.9%) digits were completely amputated and 125 (63.1%) were not. Half of the replantation procedures (101, 51.0%) were performed during night shift (16:00-00:00), 69 (34.8%) during day shift (08:00-16:00) and 28 (14.1%) during graveyard shift (00:00-08:00). Multivariate logistic regression demonstrated that the trauma mechanism and type of amputation (complete vs. incomplete) significantly affect the survival rate of replantation. Conclusions: The trauma mechanism and type of amputation (complete vs. incomplete) significantly affect the survival rate of replantation. Other factors including duty shift and the level of operator did not reach statistically significance. Further studies must be conducted to validate the results of the current study. Level of Evidence: Level III (Prognostic).

The Roles of Injury Type, Injury Level and Amputation Type in the Need for Revision Surgery after Replantation: Retrospective Clinical Outcome with 296 Finger Replantation

Background With the development of microsurgical techniques, the replantation survival rate has increased, but in some cases, revision surgery is required. Although there are many studies on replantation survival rate, studies on revision surgery are limited. In this study, we evaluated replantation patients requiring revision surgery in terms of amputation level, injury type, and amputation type (single-multiple). Methods This is a retrospective study.Two hundred fifty-six patients (296 fingers) who were operated on for total finger amputation in our hospital between 2013 and 2018 were included in the study. In the postoperative period, revision surgery was required for 24 fingers due to vascular insufficiency. Patients were evaluated in terms of amputation level, injury type, and amputation type. Results Two hundred sixty-four fingers were saved after primary surgery. Eight fingers failed before they could undergo revision surgery. Revision surgery was performed for 24 fingers. After revision surgery, 19 fingers were saved, and five fingers were failed. There was no significant effect of gender and age in terms of revision (p > 0.05).There was no statistically significant difference in injury level and injury type, but there was a statistically significant difference in terms of amputation type (p < 0.05). Conclusion Despite advanced microsurgery and experience, vascular insufficiency can be observed after replantation. Surgical re-exploration is necessary for salvage.

Comparing digital replantation versus revision amputation patient reported outcomes for traumatic digital amputations of the hand: A systematic review and meta-analysis.

Adults with traumatic digital amputation (TDA) of the hand may be managed with replantation or revision amputation. To date, there is no systematic review evaluating patient reported outcomes (PROs) comparing replantation versus revision amputation. Three databases (MEDLINE, EMBASE, and PubMed) were systematically searched in duplicate from inception until June 13, 2019 using Covidence software. Studies comparing replantation versus revision amputation outcomes were considered for inclusion. Methodological quality was assessed using Methodologic Index for Nonrandomized Studies (MINORS) criteria. Data were pooled in a random-effects meta-analysis model using Revman software. Certainty of evidence was evaluated using Grading of Recommendations, Assessment, Development, and Evaluations (GRADE). Of 4350 studies identified, 12 retrospective cohort studies met inclusion criteria and compared TDA outcomes for replantation (n = 717; 82.9% male; mean age 40.3) versus revision amputation (n = 1046; 79.8% male; mean age 41.7). The overall replantation survival rate was 85.3%. The average MINORS score was 57% (13.75/24). Replantation of the thumb had a superior Michigan Hand Questionnaire (MHQ) score (+11.88, 95% CI [7.78-15.99], I2 = 21%) compared with revision amputation. Replantation of single non-thumb digits had a superior MHQ score (+5.31, 95% CI [3.10-7.51], I2 = 67%) and Disability of Arm, Shoulder, and Hand (DASH) score (-5.16, 95% CI [-8.27 to -2.06], I2 = 0%) compared with revision amputation. Most patients in the meta-analysis were from Asian populations (87.9%). There is low-quality evidence that thumb replantation achieves superior PROs compared with revision amputation, which may be clinically important. Replantation of single non-thumb digits also yielded superior PROs, which is likely not clinically important and based on very low-quality evidence. Future studies with populations outside Asia are required to determine if PROs vary based on cultural differences toward digital amputation.

Analysis of Outcomes of Tamai Zone I Digital Replantation in Cases of Severe Crushing Injury

Purpose: Digital replantation has dramatically changed the fate of mutilated injuries of hand. But in case of severe crushing injury in Tamai zone I, it is a contraindication of replantation. This study aims to determine the replantation survival rate in cases with crushing injury.Methods: We retrospectively evaluated patients’ charts and photos from January 2015 to December 2019. There were 294 patients (331 fingers) with digital amputation who underwent surgery. Cases with crushing were divided into petechiae-in-skin group and red-line-sign group and compared with the group without crushing. The relationship of survival rate with factors was evaluated using chi-square analysis.Results: Of these, 199 fingers were defined as severe crushed, and 140 cases with petechiae in skin and 59 cases with red line sign. There was no statistically significant difference in survival rate compared with the group without crushing (p=0.227). Additional surgery was performed more in crushed injury. However, necrotized soft tissue was mainly on margin of amputation, not on crushed area.Conclusion: The presence of crushing did not affect survival rate in Tamai zone I replantation. However, as the degree of crushing was severe, the need for additional surgery increased. We found that the number of anastomosed arteries and veins influences the survival rate. According to our analysis, even if it’s difficult, finding and doing anastomosis as many vessels as possible can make good results.

Comparing Digital Replantation Versus Revision Amputation Patient-reported Outcomes for Traumatic Digital Amputations of the Hand: A Systematic Review and Meta-analysis

Purpose Adults with traumatic digital amputation (TDA) of the hand may be managed with replantation or revision amputation. To date, there is no systematic review evaluating patient reported outcomes (PROs) comparing replantation versus revision amputation. Methods Three databases (MEDLINE, EMBASE, and PubMed) were systematically searched in duplicate from inception until June 13, 2019 using Covidence software. Studies comparing replantation versus revision amputation outcomes were considered for inclusion. Methodological quality was assessed using Methodologic Index for Nonrandomized Studies (MINORS) criteria. Data were pooled in a random-effects meta-analysis model using Revman software. Certainty of evidence was evaluated using Grading of Recommendations, Assessment, Development, and Evaluations (GRADE). Results Of 4350 studies identified, 12 retrospective cohort studies met inclusion criteria and compared TDA outcomes for replantation (n = 717; 82.9% male; mean age 40.3) versus revision amputation (n = 1046; 79.8% male; mean age 41.7). The overall replantation survival rate was 85.3%. The average MINORS score was 57% (13.75/24). Replantation of the thumb had a superior Michigan Hand Questionnaire (MHQ) score (+11.88, 95% CI [7.78-15.99], I2 = 21%) compared with revision amputation. Replantation of single non-thumb digits had a superior MHQ score (+5.31, 95% CI [3.10-7.51], I2 = 67%) and Disability of Arm, Shoulder, and Hand (DASH) score (-5.16, 95% CI [-8.27 to -2.06], I2 = 0%) compared with revision amputation. Most patients in the meta-analysis were from Asian populations (87.9%). Conclusion There is low-quality evidence that thumb replantation achieves superior PROs compared with revision amputation, which may be clinically important. Replantation of single non-thumb digits also yielded superior PROs, which is likely not clinically important and based on very low-quality evidence. Future studies with populations outside Asia are required to determine if PROs vary based on cultural differences toward digital amputation.

Application of modified arterial venalization in replantation of distally severed finger at nail root without venous anastomosis

Objective To introduce an improved method of reconstructing venous reflux in replantation of distally severed finger at nail root, and explore its clinical efficacy. Methods From January 2016 to September 2018, 12 patients with 13 distally severed fingers at nail root were replanted. There were no veins to anastomose the two severed ends. The proximal bilateral proper digital artery was anastomosed with the distal digital artery or two branches. The proximal digital artery was cut off and anastomosed with the proximal dorsal digital vein to establish venous reflux. Results In 13 replanted fingers, 1 finger had partial necrosis due to serious tissue contusion, and the other 12 fingers survived completely. No venous crisis occurred after operation. The postoperative follow-up time ranged from 3 to 9 months with an average of 6.0 months. The skin texture of replanted finger was good, the nail grew well, and the sensation recovered to over S3. The patient was satisfied with the appearance and function. Conclusion The modified arterial venalization can effectively solve the venous reflux problem in venous deficiency and improve the survival rate of replantation of distally severed finger at nail root. It is an effective way to reconstruct venous reflux in the absence of severed veins. Key words: Replantation; Treatment outcome; Arterial venalization; Venous reflux

Analysis of psychological state and its influencing factors after replantation of severed finger

Objective To observe the psychological state of patients after digital replantation and analyze its influencing factors. Methods A total of 80 cases of patients with digital replantation in this hospital from February 2017 to February 2018 were selected as the research objects.The psychosocial status of the patients was assessed by the symptom self-rating scale (SCL-90) at 3 days, 1 month and 3 months after the operation, respectively, and the relationship between the psychosocial status and the patients' age, gender, education level, severity of the disease, social support, self-efficacy and personality characteristics were analyzed. Results The scores of anxiety and horror at 1day after operation were significantly higher than those in norm (P<0.05). The gender, post-injury admission time, warm ischemia time and social support were closely related to the psychological state of patient at 1day after operation (P<0.05). At 1 month after operation, the three dimensions scores of somatization, depression and paranoia were significantly higher than those in norm (P<0.05). Gender, family income, social support and medical coping style were related to psychological state of patients 1 month after surgery (P<0.05). At 3 months after operation, the four dimensions scores of coercion, interpersonal relationship, hostility and paranoia were significantly higher than those in norm (P<0.05). Family income, marital status, social support, Eysenck's personality traits and medical coping style were related to the psychological state of patients at 3 months after operation (P<0.05). Gender was an independent risk factor for patients' psychological state 1 day after surgery and 1 month after surgery.Family income was an independent risk factor for patients' psychological state 1 month after surgery and 3 months after surgery, and social support was an independent risk factor for patients' psychological state at each stage after surgery. Conclusions Patients at different stages after replantation have different psychological problems and their influencing factors are also different, among which social support affects the psychological state of patients at various stages, and intervention can be carried out according to the period and characteristics of patients to improve the survival rate of replantation. Key words: After replantation; Psychological state; Influencing factors

Clinical efficacy of finger replantation in the treatment of complete distal segment finger amputations and the analysis of the factors affecting the survival rate of patients with replantation of severed finger

Objective To observe the clinical effect of replantation and non-finger replantation in the treatment of complete distal segment finger amputations, and to analyze the related factors affecting the survival rate of replantation of amputated finger, so as to provide an objective reference for clinical treatment. Methods From March 2015 to June 2016, sixty-two patients with complete distal segment finger amputations treated in the Third People′s Hospital of Huizhou were randomly divided into two groups: the observation group and the control group according to the random number table method.The observation group was treated with finger replantation (Pancreatic repair, orthotopic suture and stump remodeling); the two groups of patients with early finger survival rate, replanting fingernail growth, two points discrimination, distal fingertips The clinical data of 288 patients with replantation of single finger rupture were analyzed retrospectively.The clinical data were divided into two groups: the survivors group, the survivors group 74 cases, compared the clinical data of the two groups of patients, analysis of the impact of replantation of the survival rate of the relevant factors. Results The survival rate of early finger was 8.57% (3/35) in the observation group and 15.15% (5/33) in the control group, the difference was not statistically significant (χ2=0.216, P>0.05). At 6 months after operation, the length of nail growth, the two-point discrimination and the distal interphalangeal mobility were significantly better than those in the control group((13.5±2.9)mmvs.(11.8±2.2)mm); (4.6±0.3)mmvs.(7.5±0.6)mm; (62.5±4.4)°vs.(45.3±3.6)°) (P complete disconnection(OR5.389, 95%CI: 2.672-7.964, P warm ischemic time more than 6 hour(OR4.515, 95%CI: 1.366-8.847, P postoperative section Thrombosis成(OR3.287, 95%CI: 2.543~9.678, P low postoperative skin temperature(OR2.142, 95%CI: 1.243-5.212, P poor postoperative knee elasticity(OR2.008, 95%CI: 1.117-5.449, P<0.001). Conclusion In the treatment of patients with complete injury from the end of the finger, the effect of replantation of the finger is significantly improved, which can improve the postoperative joint activity and improve the appearance and function of the finger.The period of severe depression, complete disconnection and warm ischemia is long Affect the survival rate of finger replantation of the main risk factors for the above factors targeted measures can improve the survival rate of finger replantation. Key words: Finger Replantation; End Finger Amputation; Survival Rate; Clinical Efficacy; Influencing Factors

Clinical study of propacetamol and dezocine for the prevention and treatment of vascular crisis in preemptive analgesia after digit replantation

Objective To explore the clinical effect of propacetamol and dezocine for the prevention and treatment of vascular crisis in the preemptive analgesia after digit replantation. Methods 85 cases of patients treated with digit replantation were selected for the study and divided into the propacetamol group (n=45) and the dezocine group (n=40) according to the different postoperative preemptive analgesic method. The two groups were given with propacetamol or dezocine and fentanyl and ondansetron patient-controlled intravenous analgesia (PCIA) respectively. The analgesic and sedative effects were observed between the two groups, and the occurrence of vascular embolism and vascular crisis and the survival rate of replantation were counted. Results There was no significant difference between the two groups in the visual analogue pain score (VAS) at 3 hours after operation (P<0.05). The VAS scores of the two groups were significantly increased at 6 h and 24 h after operation while the VAS score was significantly decreased at 48 h after operation (P<0.05), and the VAS scores were significantly lower in the propacetamol group than those in the dezocine group at 6 h, 24h and 48 h after operation (P<0.05). The difference of the Ramsay sedation scores distribution at 3 hours after operation was statistically significant between the two groups (P<0.05), and the sedative effect was more satisfactory in the propacetamol group. Within 48 h after operation, PCI effective times/actual sub values of the propacetamol group were significantly higher than the dezocine group (P<0.05). The incidence rates of postoperative vascular thrombosis and arterial or venous crisis were 4.44%, 6.67% and 6.67% respectively in the propacetamol group, which were significantly lower than those in the dezocine group with 20.00%, 22.50% and 27.50% (P<0.05). The survival rate of digit replantation, digit replantation at 6 months after treatment were 97.78%, 85.00% which was higher than that of the dezocine group with 91.11%, 75.00% (P<0.05). Conclusions Compared with dezocine, propacetamol can attain the ideal analgesic and sedative effects and improve the survival rate of replantation, which has a significant role in the prevention and treatment of vascular crisis in the adjuvant treatment of postoperative analgesia in digit replantation. Key words: Acetaminophen/AA; Acetaminophen/AD; Morphinans/AA; Morphinans/AD; Analgesia; Finger injuries/SU; Replantation; Vascular diseases/PC

Effects of two different administration methods of heparin on the survival rate of severed finger replantation

Objective To evaluate the effects of two different administration methods of heparin on the survival rate of severed finger replantation. Methods From March 2010 to January 2015, the operation of single severed finger replantation was performed on 104 patients in emergency department of our hospital. According to the different administration methods of heparin after operation, they were divided into intravenous injection group (group A) and intravenous drip group (group B), with 52 cases in each group. The incidence of vascular crisis, the survival rate of replantation and the adverse reactions were observed postoperatively. The patients were follow-up for 2 months. Results There was no significant difference between two groups in the incidence of vascular crisis and the survival rate of replantation, and the adverse reactions in intravenous injection group were significantly lower than those in intravenous drip group. Conclusion There was no significant difference in the incidence of vascular crisis and the success rate of replantation after operation between intravenous injection of heparin and intravenous drip of heparin. However, intravenous injection can reduce the adverse reactions. Key words: Replantation; Heparin; Administration method; Vascular crisis; Adverse reaction

Correlation study between survival rate of finger replantation and Type A behavior

Objective To investigate the correlation between survival rate of finger replantation and Type A behavior. Methods From March 2014 to March 2016, 217 cases of single finger replantation were enrolled in the study. Among them, the replanted fingers survived in 120 cases and died in 97 cases eventually. A behavior questionnaire was conducted at the 11th day after surgery. Results There was a significant difference in the number of type A behavior between two groups. The TH score (u=5.80,P<0.05) and TH+CH score (u=6.65,P<0.05) of the necrotic group were significantly higher than those of the survival group. Conclusion Type A behavior has a close correlation with the survival of replanted fingers. The patients with Type A behavior are easier to have replanted finger necrosis. Key words: Replantation; Questionnaires; Type A behavior; Survival rate of replantation

Application of the medullary cavity enlargement of distal finger combined with negative pressure drainage in distal finger replantation without venous anastomosis

Objective To report the clinical outcomes of the medullary cavity enlargement of distal finger combined with negative pressure drainage in distal finger replantation without venous anastomosis. Methods From January 2017 to May 2017, 8 cases (8 fingers) with amputated distal finger were replanted by the medullary cavity enlargement using 2.0-mm-diameter drill combined with negative pressure drainage using venous indwelling needle with several lateral holes. Results Partial necrosis was found in one case due to smoking. The rest 7 cases survived uneventfully. The postoperative follow-up period ranged from 1.5 to 4 months with an average of 2.0 months. The appearance of replanted fingers was satisfactory. Conclusion The medullary cavity enlargement of distal finger combined with negative pressure drainage can improve survival rate of replantation and has favourable prognosis in distal finger replantation without venous anastomosis. Key words: Replantation; Treatment outcome; Distal finger; Venous drainage

Survival Rate of Revascularization and Replantation of Digits with Vein Graft Versus Direct Arterial Anastomosis

There is no financial information to disclose. The use of vein graft in revascularization and replantation of dysvascular digit yields survival rates similar to direct arterial anastomosis. A retrospective review of all patients > 18 years old at a public urban teaching hospital from 2007 to 2017 that required revascularization and/or replantation of one or more digits due to traumatic full or partial amputation was performed. Demographic data, mechanism of injury, level of injury, and digits requiring revascularization and/or replantation were collected. In addition, length of vein graft used, donor site, and use of graft (for artery or vein) were collected. Digit survival was the primary outcome measure. 135 patients (129 male, 6 female) were identified with 186 affected digits, 127 of which required revascularization and 59 replantation. The data set included 39 thumb, 36 index, 54 middle, 38 ring, and 19 small digits. The average length of stay was 9.2 days. The average peri-operative transfusion requirement was 1.1 units (range 0-13). Vein graft for arterial anastomosis was utilized in 45.7% of all digits (53% of replanted and 40% of revascularized digits). The average vein graft length was 4.4 cm (range 0.15-12 cm). The overall digit survival rate was 80%. The 81% survival rate of digits requiring a vein graft was not different (P = 0.74) than the 79% survival rate of those that underwent direct arterial anastomosis. Similarly, the survival rate of revascularized digits was not different for digits treated with or without a vein graft (93% survival for both vein grafted digits and for those treated with direct arterial anastamosis, P = 0.86). Finally, digits replanted with a vein graft survived 53% of the time compared to the 52% survival rate of those replanted without the use of a vein graft, which was also not statistically different (P = 0.94). •Vein grafts were utilized for arterial repairs in nearly half of all dysvascular digits that underwent revascularization or replantation.•There was no statistical difference in the survival rate of dysvascular digits treated with a vein graft versus those that underwent direct arterial anastomosis.•The need for a vein graft for a large zone of injury should not be considered a relative contraindication to perform revascularization or replantation of dysvascular digits.•If the zone of injury is large, surgeons should have a low threshold to use vein grafts for the revascularization or replantation of digits.

Survival Rate of Limb Replantation in Different Age Groups.

Revascularization of damaged limbs/digits is technically feasible, but indications for surgical replantation remain controversial. The authors analyzed the survival rate of upper limb amputations and the associated factors in different age groups. They grouped 371 limb/digit amputees (average age, 44 years; range, 2-85 years) treated in their hospital during the past 10 years into three groups based on age (young, ≤ 15 years, n = 12; adult, 16-64 years, n = 302; elderly, ≥ 65 years, n = 57) and analyzed their injury type (extent of injury and stump status), operation method, presence of medical complications (Charlson comorbidity index), and survival rate. There were 168 replantations, and the overall replantation survival rate was 93%. The Charlson comorbidity index of the replantation patients was 0 in 124 cases; 1 in 32; 2 in 9; and 3 in 3, but it did not show any significant difference in survival rate after replantation. Eight elderly patients (14%) did not opt for replantation. Younger patients tended to undergo replantation, but they had lower success rates due to their severe injury status. The results of this study show that the survival rate of replantation in elderly patients is equal to that in adults. Stump evaluation is important for survival, but the presence of medical complications is not associated with the overall survival rate.

Application of CNP and medical information integration in replantation during perioperation

Objective To investigate the application effect of clinical nursing path (CNP) combined with medical information integration in replantation during perioperation. Methods According to the convenience sampling method, 100 perioperative patients with replantation that admitted from January to December 2015 were selected and assigned to the CNP group and the control group according to whether they received CNP and medical information integration, with 50 cases in each group. Hospitalization time, costs, time spent on medical information, survival rate of replantation, the master degree of health education knowledge and satisfaction towards toll between two groups were compared. Results The survival rate of replantation was 98% in the CNP group, and was 96% in the control group; the hospitalization time (10.94±2.486)d and costs (19.64±3.14) thousand yuan in the CNP group were all significantly lower than that in the control group; the score of health knowledge (91.16±3.01) points and satisfaction degree (95.06±2.30) in the CNP group were significantly higher than that in the control group (t=3.008, 7.667, 8.162, 9.551; P<0.05); time spent on medical information decreased from (20.70±5.44)min to (9.48±2.16)min (t=13.518, P<0.01). Conclusions CNP and medical information integration in the perioperation of replantation can improve the efficiency of medical treatment, reduce the hospitalization time and costs; and improve patient satisfaction and the quality of health education, so it is worth of clinical application. Key words: Perioperative nursing; Hand microsurgery; Fingers replantation; Clinical nursing path; Medical information integration

Application of self-made scale in improvement of the survival rate of replantation of amputated fingers

目的 探讨断指再植术后应用自制量表对提高断指存活率的作用。 方法 应用根据断指再植术后观察要点专门设计的观察量表配合断指再植术后常规护理对58例断指再植患者进行护理观察。 结果 应用自制量表护士能准确及时地发现58例断指再植术后患者的病情变化，通知并配合医生进行抢救处理，58例患者中，断指66指，存活60指，断指存活率91%。 结论 观察量表的临床应用，使术后护理观察更全面、更细致，加强了护士临床工作的主动性，能有效提高断指再植术后断指存活率。

Impact of the number of veins repaired in short-term digital replantation survival rate

Venous congestion/insufficiency plays a major role in failure of finger replantation. Despite acceptable salvage rates with postoperative anticoagulation or leeching, operative technique remains the most important predictor of success. However, there are no indications in the literature on the benefit of anastomosing single versus multiple veins. A retrospective review of finger amputations from 2011 to 2013 was conducted. The analyzed endpoint was the finger survival rate at discharge depending on the number of veins repaired: multiple veins (group 1), only one vein (group 2), or no veins (group 3). Proportions were compared using v2 tests/Fisher's exact tests; p-value <0.05 was considered significant. Seventy-two patients with complete digital amputation were operated including 101 fingers. Twenty-seven fingers (26.7%) failed before hospital discharge, with 78% of failures due to venous complications versus 22% with an arterial etiology. Group 2 had 15 replantation failures due to venous causes as opposed to only one from group 1, representing a 1.27-fold (95% confidence interval (CI): 0.99, 1.34) increased relative risk of failure (p=0.032). Similarly, five fingers from group 3 suffered venous complications, resulting in a 1.49-fold (95% CI: 1.02, 1.73) increased likelihood of failure in comparison to group 1 (p=0.008). No significant difference was observed between having only one vein repaired versus none (RR: 1.1792, 95% CI: 0.83, 2.10, p=0.502). Efforts toward favoring two-vein repair lead to better survival of the replanted fingers. More cases need to be analyzed before formulating conclusions on specific levels of amputation with regard to venous anastomoses.

Effects of non-surgical factors on digital replantation survival rate: a meta-analysis.

Level 5*.