Digit Replantation in Children: A Nationwide Analysis of Outcomes and Trends of 455 Pediatric Patients

Berlin, Nicholas L.; Tuggle, Charles T.; Thomson, James G.; Au, Alexander

doi:10.1007/s11552-014-9628-8

Cited by 36 publications

(27 citation statements)

References 30 publications

(49 reference statements)

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“…Statistical analysis revealed that the following variables failed to influence replant survival: age, sex, zone of injury, digit number, tobacco use, ischemia time, method of preservation, and use of vein graft. The authors found that 19 studies evaluated the role of sex and survival, 4,12,13,[15][16][17][20][21][22]24,25,[27][28][29][30]32,34,35,37 13 studies evaluated the zone of injury, 13,[15][16][17][18]21,23,26,27,33,34,36,38 15 studies evaluated digit number, 4,13,15,17,[20][21][22]24,29,32,33,35,[39][40][41] 5 studies evaluated tobacco use, 4,13,…”

Section: Resultsmentioning

confidence: 99%

Predictors of Digit Survival following Replantation: Quantitative Review and Meta-Analysis

et al. 2018

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Microsurgical replantation following digital amputation has variable success rates. Sociodemographic factors and surgery-related variables have been shown to influence survival rates; however, few studies have evaluated these data systematically across a combined dataset. Therefore, the objective of this study was to analyze the current literature to identify the predictors of replant survival. A literature review was performed using the PubMed/Medline database focused on complete digit amputation/replantation studies. Studies were evaluated for patient and surgery-related variables and their respective effects on survival. Statistical analysis was conducted to identify predictors of survival and derive pooled estimates from the combined dataset. Thirty-two studies representing more than 6,000 digit amputation/replantation cases met inclusion/exclusion criteria. Statistical analysis revealed the number of venous anastomosis (0 vs. 1 vs. 2), the number of arterial anastomosis (0 vs. 1 vs. 2), and the mechanism of injury (sharp cut versus blunt cut versus avulsion versus crush) to influence replant survival ( < 0.05). The authors failed to find a significant association between survival and the following variables: age, sex, zone of injury, digit number, tobacco use, ischemia time, method of preservation, and use of vein graft. Patient- and surgery-related variables affect digit survival following replantation. The etiology of injury can help risk-stratify patients and assist in an informed decision making process, whereas surgery-related factors can guide surgeon practice to improve clinical outcomes following replantation.

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Section: Resultsmentioning

confidence: 99%

Predictors of Digit Survival following Replantation: Quantitative Review and Meta-Analysis

et al. 2018

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“…Variables considered as candidates for a treatment decision rule ( Downloaded From: https://jamanetwork.com/ on 09/12/2020 amputation, dominant hand injury, amputation level, mechanism of injury, and bilateral injury because these factors are clinically relevant to decision-making. 7,9,12,13,23,24 In addition to these candidate variables, possible confounding variables included in the propensity model included sex, race/ethnicity, educational level, income level, marital status, employment status, occupation group, location of care, work-related injury, insurance, and insurance type.…”

Section: Explanatory Variablesmentioning

confidence: 99%

Assessment of Tree-Based Statistical Learning to Estimate Optimal Personalized Treatment Decision Rules for Traumatic Finger Amputations

et al. 2020

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IMPORTANCE Optimal treatment for traumatic finger amputation is unknown to date. OBJECTIVE To use statistical learning methods to estimate evidence-based treatment assignment rules to enhance long-term functional and patient-reported outcomes in patients after traumatic amputation of fingers distal to the metacarpophalangeal joint. DESIGN, SETTING, AND PARTICIPANTS This decision analytical model used data from a retrospective cohort study of 338 consenting adult patients who underwent revision amputation or replantation at 19 centers in the United States and Asia from August 1, 2016, to April 12, 2018. Of those, data on 185 patients were included in the primary analysis. EXPOSURES Treatment with revision amputation or replantation. MAIN OUTCOMES AND MEASURES Outcome measures were hand strength, dexterity, handrelated quality of life, and pain. A tree-based statistical learning method was used to derive clinical decision rules for treatment of traumatic finger amputation. RESULTS Among 185 study participants (mean [SD] age, 45 [16] years; 156 [84%] male), the median number of fingers amputated per patient was 1 (range, 1-5); 115 amputations (62%) were distal to the proximal interphalangeal joint, and 110 (60%) affected the nondominant hand. On the basis of the tree-based statistical learning estimates, to maximize hand dexterity or to minimize patient-reported pain, replantation was found to be the best strategy. To maximize hand strength, revision amputation was the best strategy for patients with a single-finger amputation but replantation was preferred for all other injury patterns. To maximize patient-reported quality of life, revision amputation was the best approach for patients with dominant hand injuries, and replantation was the best strategy for patients with nondominant hand injuries. CONCLUSIONS AND RELEVANCE The findings suggest that the approach to treating traumatic finger amputations varies based on the patient's injury characteristics and functional needs.

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“…To date, the literature provides variable conclusions regarding outcomes in children versus adult replants. 6,39 As such, we elected to include data on children in our analysis. Due to limitations in data reporting, we were unable to determine whether the chosen modality for replant revision (i.e., nonsurgical management) was influenced by the use of vein grafts during the index procedure, lack of identifiable veins available for anastomosis, or lack of distal vein targets.…”

Section: Discussionmentioning

confidence: 99%

Etiology and Survival of Secondary Revascularizations after Hand and Digit Replantations

Shaterian¹,

Sayadi²,

Anderson³

et al. 2020

Journal of Hand and Microsurgery

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Objective Hand and digit replantations can be complicated by vascular insufficiency necessitating revision of the original replantation. To date, few studies have evaluated outcomes in secondary revascularizations following replantation. Therefore, the objective of this study was to evaluate the incidence, etiology, and survival rates following secondary revascularization after hand and digit replantations. Materials and Methods A literature search was performed on NCBI for studies documenting secondary revascularization procedures following hand and digit replant. Studies were evaluated for the etiology of vascular failure, frequency of secondary revascularization, and survival rates following intervention. Statistical analysis was conducted across the pooled dataset. Results A total of 16 studies including 1,192 amputations were analyzed. We found that 16.9% (201/1,192) of replants were complicated by vascular compromise. The frequency of vascular compromise was not statistically different between arterial and venous etiologies. The survival rate following secondary revascularization was 55.6%, with no significant difference between the arterial and venous groups. Secondary arterial revascularization was often treated with arterial revision (nine of nine studies) and/or with vein grafting (two of nine studies). Secondary revascularization for venous insufficiency resulted in different survival rates for nonsurgical modalities (58%) versus vein revision (37.5%) versus vein grafting (100%). Conclusion Survival rates following secondary revascularization are lower; however, they may be improved using vein grafts following venous insufficiency. These data can be used to better understand the etiology of replant failure and guide decision-making.

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Digit Replantation in Children: A Nationwide Analysis of Outcomes and Trends of 455 Pediatric Patients

Cited by 36 publications

References 30 publications

Predictors of Digit Survival following Replantation: Quantitative Review and Meta-Analysis

Predictors of Digit Survival following Replantation: Quantitative Review and Meta-Analysis

Assessment of Tree-Based Statistical Learning to Estimate Optimal Personalized Treatment Decision Rules for Traumatic Finger Amputations

Etiology and Survival of Secondary Revascularizations after Hand and Digit Replantations

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