A Global View of Digital Replantation and Revascularization

Tang, Jin Bo; Wang, Zeng Tao; Chen, Jing; Wong, Jason

doi:10.1016/j.cps.2016.11.003

Cited by 18 publications

(5 citation statements)

References 36 publications

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“…Proximal limb replants are not recommended after warm ischemia of more than 2 hours and cold ischemia of more than 6 hours. 13 In our series, proximal replants after 6 hours of cold ischemia were not attempted. Due to more muscle bulk in all these cases, there is a high risk of reperfusion injury.…”

Section: Discussionmentioning

confidence: 98%

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Review of Replantation Services from a Level One Trauma Center in India

Dash,

Tiwari,

Dawar

et al. 2023

Journal of Hand and Microsurgery

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The aim of this article is to examine the elements that contribute to effective operation of a specialized replantation center and to provide readers with a general idea of the outcome of replantation services in India. A dedicated high-volume center coupled with a sound referral system is the backbone of replantation services in a country. A retrospective study was done on all patients who visited a level 1 trauma center in India from November 1, 2017, to December 31, 2018, for various amputations. The medical records and digital pictures of these patients were extracted from the records and analyzed. During the study period, 77 replants were performed on 63 patients at our center. Males were 68% of the study, mostly belonging to the 20 to 40 years age group (63%). Thirty-four percent of cases were smokers. Agricultural injuries (49%) were the most common cause of amputation. Finger replantation was the most common type of replantation (82%). The rate of successful replantation was highest for scalp (100%) followed by hand (71%) and thumb (67%). Setting up dedicated replantation services is essential, especially in highly populated areas. Manpower, resources, and a protocol-led approach help in achieving optimum results. A multidisciplinary team approach with round-the-clock availability plays a vital role in intraoperative decision-making and planning postoperative rehabilitation.

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Section: Discussionmentioning

confidence: 98%

“…First-generation cephalosporins or amoxicillin-clavulanic acid were used in clean-cut replantation and aminoglycosides, in addition, were administered in contaminated cases. 6,12,13…”

Section: Patient and Methodologymentioning

confidence: 99%

Review of Replantation Services from a Level One Trauma Center in India

Dash,

Tiwari,

Dawar

et al. 2023

Journal of Hand and Microsurgery

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“…People, especially women, are hesitant to lose toes for reconstructive surgical procedures such as toe transfer or wraparound flap, particularly in countries where people dislike body defects or regularly wear open-toed shoes in daily life. 16 , 17 , 18 , 19 , 20 , 21 , 22 Wang and Sun 23 claimed that donor sites of wraparound flap were as unattractive as bound feet.…”

Section: Discussionmentioning

confidence: 99%

Aesthetic Reconstruction of Fingers and Thumbs With the Vascularized Half–Big Toenail Flap With Minimum Donor Site Morbidity

Kobayashi

Masuyama

Nishimura

2020

Journal of Hand Surgery Global Online

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The vascularized halfebig toenail flap is a short-pedicle free vascularized flap approximately 30 mm in size that contains a fibular half-nail with a 5-mm skin edge and the partial distal phalanx bone. The fingertip skin of the amputated finger is reflected to cover the skin deficiency. The sensation and function are maintained at the donor site, and primary wound closure of the donor site is possible. This study aimed to evaluate the clinical outcomes of thumb and finger reconstruction operations performed using this flap. Methods: We assessed 16 patients (19 digits) with digit amputation who underwent this procedure. We evaluated the following parameters: reconstructed digits, amputation level, survival rate, period until bone union, elongated length, morphologic indices, feeding artery, vein distribution, static 2-point discrimination, and patient occupation. We used the Michigan Hand Outcomes Questionnaire for the evaluation of the function and appearance of the arm. Results: We reconstructed 3 thumbs and 16 fingers. No patients with zone I or V or palm amputation underwent surgery. Flap survival was obtained in all cases, including one atrophic case. Elongated length was 14.1 mm (range, 0e30 mm). The width and longitudinal/axial convexity of the transferred nail increased and the length decreased, whereas the width of the donor site nail increased at final follow-up. Reasonable sensation of the flap was obtained. The feeding artery was the plantar digital artery in 15 toes, the branch in 1, and the arterial anonymous vessel in 3. We could harvest the vein in the first web in 16 toes. All patients went back to their former jobs. Conclusions: The aesthetic and functional outcomes of the reconstructed thumbs and fingers significantly improved. Donor site functional morbidity was minimum. Nevertheless, patients' expectations regarding the reconstructed digit seemed to be that of an intact digit. Type of study/level of evidence: Therapeutic IV.

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“…Following repair of the volar structures, the hand is turned and the dorsal structures such as the vein and extensor tendons are repaired. This method saves time and avoids manipulation of the digits after replantation, however, it increases ischaemia time as all fingers are exposed to warm ischaemia until the revascularisation is complete; there is also the possibility of increased blood loss 1,19…”

Section: Discussionmentioning

confidence: 99%

“…The possible functional outcome and the timeframe for recovery should be clearly discussed with the patient. In addition, it is essential that an informed consent be obtained before proceeding with any procedure to avoid any liability 19…”

Section: Discussionmentioning

confidence: 99%

Replantation of Nine Fingers in a Patient: A case report

Patil

Malhotra

Venugopal

et al. 2019

Sultan Qaboos Univ Med J

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Amputation of multiple fingers of both hands is a rare and serious injury. We report a case of a 41-year-old male patient who presented to Khoula Hospital, Muscat, Oman, in 2015 with the amputation of nine fingers due to a workplace injury. With two teams working in tandem, all the amputated fingers were re-attached. A total of seven fingers survived and the patient regained reasonable functionality of his hands. To the best of the authors’ knowledge, this is the first case of several finger amputations in Oman.Keywords: Fingers; Traumatic Amputation; Crush Injuries; Replantation; Case Report; Oman.

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A Global View of Digital Replantation and Revascularization

Cited by 18 publications

References 36 publications

Review of Replantation Services from a Level One Trauma Center in India

Review of Replantation Services from a Level One Trauma Center in India

Aesthetic Reconstruction of Fingers and Thumbs With the Vascularized Half–Big Toenail Flap With Minimum Donor Site Morbidity

Replantation of Nine Fingers in a Patient: A case report

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