Survival Rate of Limb Replantation in Different Age Groups

Abstract

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, = 12; adult, 16-64 years, = 302; elderly, ≥ 65 years, = 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.

Association of Interfacility Transfer and Patient and Hospital Characteristics With Thumb Replantation After Traumatic Amputation

“… 1 , 8 , 21 However, in other developed countries including Taiwan, Japan, and China, rates of replantation and success rates are higher than in the US. 10 , 22 , 23 , 24 Specialized replantation centers in these countries that streamline replantation care may contribute to the replantation success. Therefore, establishing centers of excellence for digit replantation in the US may help mitigate this decrease in replantation through concentration of case volume, referral network development, and streamlined delivery of replantation care through specialization.…”

“… 8 In contrast, in countries such as China and Japan replantation success rates are approximately 90%. 10 …”

“…8 In contrast, in countries such as China and Japan replantation success rates are approximately 90%. 10 Replantation requires complex microsurgical expertise, which is not available at all facilities; therefore, interfacility transfer is commonly required. Interfacility transfer may be associated with delays in care and thus with overall patient outcomes.…”

“…In the US, replantation success rates have decreased from approximately 75% in the early 2000s to approximately 66% from 2010 to 2012 . In contrast, in countries such as China and Japan replantation success rates are approximately 90% …”

Successful Hand Replantation Augmented by Delayed Pedicled Fascio-Cutaneous Groin Flap in an Adult Laborer: A Case Report and Literature Review

“…An amputation of the upper limb is a devastating injury and the subsequent replantation is a serious challenge to the reconstructive surgeon, with a range of difficulties greater than that encountered in replanting digits [ 9 ]. With modern surgical techniques, better outcomes are obtained, with even elderly patients having as good a chance of replantation as younger individuals [ 10 ]. Traumatic amputation may be accompanied by mutilating injuries to soft tissue of the severed part, which leads to tissue necrosis and sepsis, and this is the most common cause of limb loss following replantation [ 2 ].…”