Digit and hand replantation

Beris, Alexandros E.; Lykissas, Marios G.; Korompilias, Anastasios V.; Mitsionis, G.; Vekris, Marios D.; Kostas-Agnantis, Ioannis

doi:10.1007/s00402-009-1021-7

Cited by 82 publications

(85 citation statements)

References 41 publications

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“…In the US, replantation is generally not indicated if there has been an extended ischemia time, for crush or avulsion injuries, for amputations distal to the PIP joint, or for single digit amputation. [11][12][13] In fact, replantation has been shown to be not be a cost-effective treatment for a single digit amputation; replantation only becomes costeffective when replanting 3-4 digits. 14 In Japan, however, all types of digit amputations are A focus on aesthetics over function in Japanese patients may be due to Confucian teachings that maintain that the body is a gift from one's parents and therefore must be safeguarded.…”

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confidence: 99%

Direct-to-Implant Single-Stage Immediate Breast Reconstruction with Acellular Dermal Matrix

Gdalevitch

Genoway

et al. 2014

Plastic &Amp; Reconstructive Surgery

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Purpose-Large geographic differences in utilization of a procedure draw into question its appropriate use. In Japan, replantation is commonly conducted for even very distal finger amputations. In the US, revision amputation is far more common. There has been no detailed investigation into the drivers of these differences.Methods-We created a survey to assess surgeons' experience with replantation, estimates of physical and functional outcomes, attitudes toward amputees, and preferences in several injury scenarios. The survey was distributed to members of the Finger Replantation and Amputation Multicenter (FRAM) Study and to hand surgeons making podium presentations at the Central Japanese Society for Surgery of the Hand Annual Meeting.Results-100% of both groups responded. There were no significant differences in experience with finger replantation. Japanese hand surgeons were significantly more likely to recommend replantation in all scenarios, despite 62% ranking function 6 months after replantation as "poor." Japanese surgeons rated the appearance of a hand with an amputated finger significantly poorer than American surgeons. Japanese surgeons were also significantly more likely to report stigmatization against finger amputees.Conclusion-There is no high level of evidence study comparing outcomes following replantation and revision amputation. The lack of evidence results in surgeons basing recommendations on personal preference. In this case, Japanese surgeons preferred replantation despite agreeing that functional outcomes were suboptimal. This may be because of Japanese cultural beliefs. Comparative effectiveness research, like that planned by the FRAM study, can help elucidate the appropriate utilization of finger replantation based on evidence.Corresponding author and reprint requests sent to: Kevin C Chung, MD, MS, Professor of Surgery, Section of Plastic Surgery, Assistant Dean for Faculty Affairs, University of Michigan Medical School, 2130 Taubman Center, 1500 W Medical Center Dr, Ann Arbor, MI 48109-0530, Phone: 734-615-3435, kecchung@umich.edu. Hand injuries pose a worldwide burden. Much of the world relies on manual labor such as farming and factory work for sustenance and income. In these cases, revision amputation, which allows for quicker return to work while largely maintaining function, is the preferred treatment. Despite more oversight by many countries in developing safety measure to protect workers, amputation of digits occurs frequently, even in highly developed countries such as the US and Japan. In these regions surgeons are engaged in intense microsurgical training and have access to advanced surgical technology and are able to replant amputated digits successfully. The use of this procedure is variable, however. In Japan and other parts of Asia, ever expanding indications for finger replantation mean the procedure is performed with increasing frequency. 3,4 In contrast, finger replantation is performed by a small fraction of hand surgeons at only 15% of American hospitals. 5,6...

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confidence: 99%

Direct-to-Implant Single-Stage Immediate Breast Reconstruction with Acellular Dermal Matrix

Gdalevitch

Genoway

et al. 2014

Plastic &Amp; Reconstructive Surgery

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“…For nearly 100 years, no notable advances have occurred, and vascular grafts continue to undergo restenosis and thrombosis resulting in vascular occlusions, prolonged hospital stays and mortality [5][6][7][8] . In addition, sutured anastomoses are unreliable in small (<1.0 mm) or diseased vessels, which tend to fracture and are often regarded as contraindications to revascularization 9,10 . A number of devices have attempted to overcome the technical difficulties of sutures, but often the use of microclips, staples or magnets is itself traumatic to blood vessels, leading to failure rates comparable to or higher than those of sutured anastomoses [11][12][13][14] .…”

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Vascular anastomosis using controlled phase transitions in poloxamer gels

Chang

Galvez

Glotzbach

et al. 2011

Nat Med

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Vascular anastomosis is the cornerstone of vascular, cardiovascular and transplant surgery. Most anastomoses are performed with sutures, which are technically challenging and can lead to failure from intimal hyperplasia and foreign body reaction. Numerous alternatives to sutures have been proposed, but none has proven superior, particularly in small or atherosclerotic vessels. We have developed a new method of sutureless and atraumatic vascular anastomosis that uses US Food and Drug Administration (FDA)-approved thermoreversible tri-block polymers to temporarily maintain an open lumen for precise approximation with commercially available glues. We performed end-to-end anastomoses five times more rapidly than we performed hand-sewn controls, and vessels that were too small (<1.0 mm) to sew were successfully reconstructed with this sutureless approach. Imaging of reconstructed rat aorta confirmed equivalent patency, flow and burst strength, and histological analysis demonstrated decreased inflammation and fibrosis at up to 2 years after the procedure. This new technology has potential for improving efficiency and outcomes in the surgical treatment of cardiovascular disease.

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“…Such results can only be achieved by experienced surgeons who are aware of all relevant factors such as the patient's general state of health (''life before limb'' concept [17]), the risks involved in replantation, the technical possibility and feasibility for replantation, the possible complications and the potential need for secondary surgery. Due to the rarity of these replantations, they should be performed at specialized replantation centers where surgeons can adapt quickly to all possible cases [18]. In this context, Ozçelik et al [19] and Liang et al [20] have recently underlined the possible indication for cross-extremity replantation when the patient suffers from bilateral total amputation at different levels and orthotopic replantation is impossible.…”

Section: Discussionmentioning

confidence: 99%

Macroreplantations of the upper extremity: a series of 11 patients

Leclère

Mathys

Juon

et al. 2012

Arch Orthop Trauma Surg

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Introduction Micro-or macroreplantation is classified depending on the level of amputation, distal or proximal to the wrist. This study was performed to review our experience in macroreplantation of the upper extremity with special attention to technical considerations and outcomes. Materials and methods Between January 1990 and December 2010, 11 patients with a complete amputation of the upper extremity proximal to the wrist were referred for replantations to our department. The patients, one woman and ten men, had a mean age of 43.4 ± 18.2 years (range 19-76 years). There were two elbow, two proximal forearm, four mid-forearm, and three distal forearm amputations. The mechanism of injury was crush in four, crush-avulsion in five and guillotine amputation in two patients. The Chen classification was used to assess the postoperative outcomes. The mean follow-up after macroreplantation was 7.5 ± 6.3 years (range 2-21 years). Results All but one were successfully replanted and regained limb function: Chen I in four cases (36 %), Chen II in three cases (27 %), Chen III in two cases (18 %), and Chen IV in one patient (9 %). We discuss the steps of the macroreplantation technique, the need to minimize ischemic time and the risk of ischemia reperfusion injuries. Conclusion Thanks to improvements in technique, the indications for limb preservation after amputation can be expanded. However, because of their rarity, replantations should be performed at specialist replantation centers. Level of evidence: Level IV

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Digit and hand replantation

Cited by 82 publications

References 41 publications

Direct-to-Implant Single-Stage Immediate Breast Reconstruction with Acellular Dermal Matrix

Direct-to-Implant Single-Stage Immediate Breast Reconstruction with Acellular Dermal Matrix

Vascular anastomosis using controlled phase transitions in poloxamer gels

Macroreplantations of the upper extremity: a series of 11 patients

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