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Pugliese P, Vulpetti M, Tondini G, Toia F. Flexor Tendon Continuity and Negative X-ray: The "Combo" Negative Features in Finger Subamputation. J Clin Med 2024; 13:3331. [PMID: 38893042 PMCID: PMC11172924 DOI: 10.3390/jcm13113331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2024] [Revised: 05/29/2024] [Accepted: 06/01/2024] [Indexed: 06/21/2024] Open
Abstract
Background: The subamputation of fingers with vascular compromise presents a surgical challenge. Although tissue continuity may be considered a favourable prognostic element, in our experience, we noticed that there is not always a direct correlation between soft tissue involvement, radiographic appearance and final outcome. Methods: We included, in our study, all cases of vascular pedicle injury in which finger salvage was attempted with microsurgical revascularisation. Exclusion criteria were: integrity of both vascular pedicles, pedicle lesion without global circulatory compromise and patients treated immediately with amputation. Results: Between May 2018 and July 2023, 27 male patients with finger subamputation injuries were treated at our institution. In 11 cases of injured fingers, the only intact tissue was the flexor digitorum profundus (FDP) or flexor pollicis longus (FPL). Our global failure rate was 49%; whereas, in the subgroup of the 11 cases with continuity of the FDP or FPL, the failure rate rose to 73% and when the fingers showed flexor tendon integrity and radiographs demonstrated minimal bone damage, revascularisation failure was observed in all cases (100%). Conclusions: The results of the study show that subamputations with devascularisation, clinically presented with the combination of flexor tendon as the only element of tissue continuity and dislocation or minimal bone/articular injury, have a worse prognosis because of their trauma mechanism. We propose to add them to the Kay-Adani Classification as a subset of the poorest prognostic injuries group (III), to help surgeons to make decisions about the management of subamputation finger injuries.
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Affiliation(s)
- Pierfrancesco Pugliese
- Plastic and Reconstructive Surgery, Department of Precision Medicine in Medical, Surgical and Critical Care, University of Palermo, 90127 Palermo, Italy; (M.V.); (G.T.); (F.T.)
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Tuaño KR, McCarty JC, Fisher MH, Eberlin KR. Outcomes following replantation surgery. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2023:10.1007/s00590-023-03729-1. [PMID: 37755559 DOI: 10.1007/s00590-023-03729-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 09/04/2023] [Indexed: 09/28/2023]
Abstract
The ability to perform surgical replantation of individual digits and limbs can provide substantial functional improvement for patients who sustain devastating upper extremity injuries. Defining success in replantation surgery extends beyond the acute period and the binary metrics of survival or loss of the replanted part to include the long-term overall functional outcomes. Functional outcomes include both objective clinical evaluation and patient-reported outcomes. There has been significant variation in the way outcomes following replantation are measured, which inherently leads to heterogeneity in the reported outcome data. Given the variability among outcome measures, we aim to explore the outcomes of replantation surgery, particularly clinical evaluation and patient-reported functional outcomes following replantation.
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Affiliation(s)
- Krystle R Tuaño
- Division of Plastic and Reconstructive Surgery, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA
| | - Justin C McCarty
- Division of Plastic and Reconstructive Surgery, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA
| | - Marlie H Fisher
- Division of Plastic and Reconstructive Surgery, University of Colorado Hospital, Denver, CO, 80045, USA
| | - Kyle R Eberlin
- Division of Plastic and Reconstructive Surgery, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA.
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3
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Sinatro H, Massand S, Ingraham J. Proper preservation of amputated parts: A multi-level shortcoming. Am J Emerg Med 2021; 52:155-158. [PMID: 34922236 DOI: 10.1016/j.ajem.2021.12.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Revised: 11/29/2021] [Accepted: 12/03/2021] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Successful replantation relies on proper preservation of traumatically amputated parts. The established protocol for preservation, however, is inconsistently adhered to. The objective of this study is to examine the rate of proper preservation in multiple patient populations. METHODS A retrospective review of patients from 2015 to 2019 at a single academic institution was conducted. Patients were included if they suffered a traumatic amputation, the amputated part was present for evaluation by the hand surgery team, and modality of preservation was documented. Additional data including method of patient transport, replantation attempt, and operative outcome were assessed. Patients were stratified based on whether proper preservation was employed and compared using chi-square tests. RESULTS Ninety-one patients were included, thirty-one (34.1%) of whom had amputated parts which were properly preserved. Patients from referring facilities were more likely to present with properly preserved parts (45.0%) than those presenting from home (25.5%), though this did not meet significance (P = .051). In total, 74 patients arrived via EMS with 35.1% adherence to preservation protocol. Of the 31 patients who had properly preserved parts, 58.1% underwent attempted replant; of the 60 patients who had improperly preserved parts, 23.3% underwent attempted replantation (P = .001). CONCLUSIONS The majority of patients who suffer traumatic amputations do not present with properly preserved amputated parts, limiting potential replantation. With a direct correlation to attempted replantation, proper preservation is a crucial aspect of care and should not be overlooked when seeking to optimize efforts and results. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Haley Sinatro
- Penn State College of Medicine, Penn State Hershey Medical Center, USA.
| | - Sameer Massand
- Division of Plastic and Reconstructive Surgery, Penn State Hershey Medical Center, USA
| | - John Ingraham
- Division of Plastic and Reconstructive Surgery, Penn State Hershey Medical Center, USA
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Erçin BS, Tatar BE, Keleş MK, Kabakaş F. 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. J INVEST SURG 2021; 35:1178-1183. [PMID: 34620039 DOI: 10.1080/08941939.2021.1988772] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
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.
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Affiliation(s)
- Burak Sercan Erçin
- Department of Plastic Surgery, Bahçeşehir University, VM Medicalpark Pendik Hospital, Istanbul, Turkey
| | - Burak Ergün Tatar
- Department of Plastic Surgery, University of Health Sciences, Bagcılar Training and Research Hospital, Istanbul, Turkey
| | - Musa Kemal Keleş
- Department of Plastic and Hand Surgery, Medicalpark Gebze Hospital, Kocaeli, Turkey
| | - Fatih Kabakaş
- Department of Plastic and HandSurgery, Medicalpark Gebze Hospital, Kocaeli, Turkey
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Shaterian A, Sayadi LR, Tiourin E, Gardner DJ, Evans GRD, Leis A. Predictors of Hand Function Following Digit Replantation: Quantitative Review and Meta-Analysis. Hand (N Y) 2021; 16:11-17. [PMID: 30938181 PMCID: PMC7818032 DOI: 10.1177/1558944719834658] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Background: Digit replantation affords the opportunity to restore hand function following amputation. To date, however, few studies have evaluated functional outcomes following replantation. Therefore, it was the objective of this study to perform a meta-analysis to better characterize the predictors of hand function. Methods: A literature search was performed using the PubMed database to identify studies that focused on digit amputation/replantation and functional outcomes. Studies were evaluated for patient- and injury-related factors and their respective effects on clinical outcomes of sensation, grip strength, and Disabilities of the Arm, Shoulder, and Hand (DASH) scores. Statistical analysis was conducted across the pooled data set to identify significant trends. Results: Twenty-eight studies representing 618 replanted digits were included in this study. We found the average grip strength was 78.7% (relative to contralateral), the average 2-point discrimination (2PD) was 7.8 mm, and the average DASH score was 12.81. After conducting statistical analysis, we found patients with more proximal injuries had lower grip strength scores (P < .05). We found 2PD scores were influenced by age, mechanism of injury, and amputation level (P < .05). Finally, we found DASH scores after replantation were predicted by mechanism of injury and level of amputation (P < .05). The following variables did not influence outcomes: gender, tobacco use, ischemia time, and digit number. Conclusions: Digit replant does not restore premorbid hand function but does result in adequate hand function. Expected functional outcomes following replant should be considered in the decision-making process. These data can help risk-stratify patients, guide postreplant expectations, and influence the decision for replantation.
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Affiliation(s)
| | | | | | - Daniel J. Gardner
- University of California, Irvine,
Orange, USA,Daniel J. Gardner, Department of Plastic
Surgery, University of California, Irvine, 200 South Manchester Avenue, Suite
650, Orange, CA 92868, USA.
| | | | - Amber Leis
- University of California, Irvine,
Orange, USA
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6
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Okyere I, Ativor V, Okyere P. Revascularization of post-traumatic leg amputation: a case report. Ghana Med J 2020; 53:308-311. [PMID: 32116344 PMCID: PMC7036437 DOI: 10.4314/gmj.v53i4.10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
There are few reports on lower extremity revascularization because of its high risks of general and local complications as well as poor functional prognosis. However, revascularization of the traumatically amputated lower extremity is a technically feasible surgical undertaking if there can be effective collaboration between the orthopaedic surgeon and the vascular surgeon. Successful outcome is usually judged by functional achievements of the patient toward returning to the preinjury level. Appropriate patient selection significantly increases the potential for obtaining a satisfactory outcome. We report the successful revascularization of a near amputation of the right leg of a young man who was knocked down accidentally by a speeding taxi leading to mangled and near amputation of his right leg. He underwent successful revascularization and currently doing well, one year after the surgery. Successful revascularization is possible if indicated in less resource countries especially if there is an experienced team of vascular and orthopaedic surgeons.
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Affiliation(s)
- Isaac Okyere
- Cardiovascular and Thoracic Surgery Unit, Department of Surgery, School of Medicine and Dentistry, College of Health Sciences , Kwame Nkrumah University of Science and Technology and Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | - Vincent Ativor
- Trauma and Orthopaedic Surgery Unit, Department of Surgery, School of Medicine and Dentistry, College of Health Sciences, Kwame Nkrumah University of Science and Technology and Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | - Perditer Okyere
- Departement of Internal Medicine, School of Medicine and Dentistry, College of Health Sciences, Kwame Nkrumah University of Science and Technology and Komfo Anokye Teaching Hospital, Kumasi, Ghana
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Charpentier K, Loisel F, Menu G, Feuvrier D, Obert L, Pluvy I. Long-term functional results of digital replantation: A survey of 28 patients. HAND SURGERY & REHABILITATION 2019; 38:375-380. [PMID: 31521798 DOI: 10.1016/j.hansur.2019.09.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/18/2019] [Revised: 08/06/2019] [Accepted: 09/06/2019] [Indexed: 11/25/2022]
Abstract
We sought to evaluate the long-term quality of life and functional outcome of patients who underwent digital replantation after amputation. A retrospective single-center study was conducted of patients treated between January 2010 to May 2016. Twenty-eight patients who underwent successful replantation after single or multiple digital amputation were reviewed in person after at least 2years' follow-up (mean 4.6years). Total active range of motion, grip and pinch strength were assessed. Functional outcomes were evaluated using the SF-36 and DASH questionnaires. The patients' occupational status and daily activities were reported. Mean total active range of motion was 42% of the contralateral healthy side. Better active mobility and higher grip strength were found when the amputation was distal to the insertion of the common flexor tendon. Mean grip and pinch strength were 80% and 65%, respectively. Fusion did not significantly influence active mobility. The mean DASH score was 22.3. In our study, 77% of the patients returned to the same job and 75% experienced cold intolerance. The majority of patients who underwent digital replantation maintain a quality of life that allows them to return to work. Fusion, especially in the thumb, can be performed with few functional consequences. Even many years after the replantation procedure, sensory recovery remains poor.
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Affiliation(s)
- K Charpentier
- Service de chirurgie orthopédique et traumatologique, chirurgie plastique, esthétique et reconstructrice, chirurgie de la main, CHRU Minjoz, 3, boulevard Alexander-Fleming, 25030 Besançon cedex, France
| | - F Loisel
- Service de chirurgie orthopédique et traumatologique, chirurgie plastique, esthétique et reconstructrice, chirurgie de la main, CHRU Minjoz, 3, boulevard Alexander-Fleming, 25030 Besançon cedex, France; Unité de recherche Nanomedicine Lab, Imagery & Therapeutics EA4662, université de Bourgogne-Franche-Comté, 16, route de Gray, 25030 Besançon, France
| | - G Menu
- Service de chirurgie orthopédique et traumatologique, chirurgie plastique, esthétique et reconstructrice, chirurgie de la main, CHRU Minjoz, 3, boulevard Alexander-Fleming, 25030 Besançon cedex, France
| | - D Feuvrier
- Service de chirurgie orthopédique et traumatologique, chirurgie plastique, esthétique et reconstructrice, chirurgie de la main, CHRU Minjoz, 3, boulevard Alexander-Fleming, 25030 Besançon cedex, France
| | - L Obert
- Service de chirurgie orthopédique et traumatologique, chirurgie plastique, esthétique et reconstructrice, chirurgie de la main, CHRU Minjoz, 3, boulevard Alexander-Fleming, 25030 Besançon cedex, France; Unité de recherche Nanomedicine Lab, Imagery & Therapeutics EA4662, université de Bourgogne-Franche-Comté, 16, route de Gray, 25030 Besançon, France
| | - I Pluvy
- Service de chirurgie orthopédique et traumatologique, chirurgie plastique, esthétique et reconstructrice, chirurgie de la main, CHRU Minjoz, 3, boulevard Alexander-Fleming, 25030 Besançon cedex, France; Unité de recherche Nanomedicine Lab, Imagery & Therapeutics EA4662, université de Bourgogne-Franche-Comté, 16, route de Gray, 25030 Besançon, France.
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8
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Abstract
The variability in reported outcomes and outcome measures used in digit replantation makes it difficult to compare results among studies. This article reviews the principles of measuring functional and patient-reported outcomes after replantation, and describes the recommended instruments to use and ways to report results.
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Affiliation(s)
- Hoyune E. Cho
- T32 Postdoctoral Research Fellow, Section of Plastic Surgery, Department of Surgery, University of Michigan Medical School, Ann Arbor, MI
| | - Sandra V. Kotsis
- Research Coordinator, Section of Plastic Surgery, Department of Surgery, University of Michigan Medical School, Ann Arbor, MI
| | - Kevin C. Chung
- Professor of Surgery, Chief of Hand Surgery, Section of Plastic Surgery, Department of Surgery, Michigan Medicine, Ann Arbor, MI
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9
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Lee DC, Kim JS, Roh SY, Lee KJ, Kim YW. Flap Coverage of Dysvascular Digits Including Venous Flow-Through Flaps. Hand Clin 2019; 35:185-197. [PMID: 30928050 DOI: 10.1016/j.hcl.2019.01.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
A dysvascular digit is defined as a threatened circulatory condition of a digit caused owing to multiple reasons, such as medical illness or trauma. A dysvascular digit always needs surgical manipulation of the vessel in trauma cases. The revascularization of the digit is a priority in such conditions, after which reconstruction of the defect is performed. In this article, the authors present and discuss the venous free flap, thenar free flap, toe plantar free flap, free style perforator flap, hypothenar free flap, and anconeus muscle free flap.
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Affiliation(s)
- Dong Chul Lee
- Department of Plastic and Reconstructive Surgery, Gwangmyeong Sungae General Hospital, 36, Digital-road, Gwangmyeong, Gyeonggi-do 14241, South Korea.
| | - Jin Soo Kim
- Department of Plastic and Reconstructive Surgery, Gwangmyeong Sungae General Hospital, 36, Digital-road, Gwangmyeong, Gyeonggi-do 14241, South Korea
| | - Si Young Roh
- Department of Plastic and Reconstructive Surgery, Gwangmyeong Sungae General Hospital, 36, Digital-road, Gwangmyeong, Gyeonggi-do 14241, South Korea
| | - Kyung Jin Lee
- Department of Plastic and Reconstructive Surgery, Gwangmyeong Sungae General Hospital, 36, Digital-road, Gwangmyeong, Gyeonggi-do 14241, South Korea
| | - Yong Woo Kim
- Department of Plastic and Reconstructive Surgery, Gwangmyeong Sungae General Hospital, 36, Digital-road, Gwangmyeong, Gyeonggi-do 14241, South Korea
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10
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Abstract
Replantation of a digit or hand is most successful when performed at a specialized, high-volume center. However, most patients with amputations initially present to local hospitals. Therefore, patients amenable to replantation frequently require expedited transfer to a tertiary center. To maximize success of digit replants, health care providers from both the referring and the referral hospital must be facile and expeditious at transferring the injured patient. The critical aspects of triage include assessment of the injury, patient communication, interfacility communication, preparation of the amputated part and patient, and a timely transfer.
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Affiliation(s)
- Shepard P Johnson
- Plastic and Reconstructive Surgery, Vanderbilt University Medical Center, 1211 Medical Center Drive, Nashville, TN 37232, USA
| | - Brian C Drolet
- Department of Plastic Surgery, Vanderbilt University Medical Center, 1211 Medical Center Drive, Medical Center North, D-4219, Nashville, TN 37232, USA; Department of Biomedical Informatics, Vanderbilt University Medical Center, 1211 Medical Center Drive, Medical Center North, D-4219, Nashville, TN 37232, USA; Center for Biomedical Ethics and Society, Vanderbilt University Medical Center, 1211 Medical Center Drive, Medical Center North, D-4219, Nashville, TN 37232, USA.
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11
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The safety of one-per-mil tumescent infiltration into tissue that has survived ischemia. Arch Plast Surg 2019; 46:108-113. [PMID: 30934173 PMCID: PMC6446036 DOI: 10.5999/aps.2018.00248] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2018] [Accepted: 01/08/2019] [Indexed: 11/29/2022] Open
Abstract
Background The aim of this study was to assess the safety of one-per-mil tumescent injections into viable skin flaps that had survived an ischemic insult, in order to assess the potential suitability of one-per-mil tumescent injections in future secondary reconstructive procedures such as flap revision and refinements after replantation. Methods Forty groin flaps harvested from 20 healthy Wistar rats weighing 220 to 270 g were subjected to acute ischemia by clamping the pedicle for 15 minutes. All flaps showing total survival on the 7th postoperative day were randomly divided into group A (one-per-mil tumescent infiltration; n=14), group B (normal saline infiltration; n=13), and group C (control, with no infiltration; n=13) before being re-elevated. Transcutaneous oxygen tension (TcPO2) was measured before and after infiltration, and changes in TcPO2 were statistically analyzed using analysis of variance, the paired t-test, and the independent t-test. The viability of flaps was also assessed using the Analyzing Digital Images software at 7 days after the second elevation. Results Thirty-nine flaps survived to the final assessment, with the sole exception of a flap from group A that did not survive the first elevation. TcPO2 readings showed significant decreases (P<0.05) following both one-per-mil tumescent (99.9±5.7 mmHg vs. 37.2±6.3 mmHg) and normal saline (103±8.5 mmHg vs. 48.7±5.9 mmHg) infiltration. Moreover, all groin flaps survived with no signs of tissue necrosis. Conclusions One-per-mil tumescent infiltration into groin flap tissue that had survived ischemia did not result in tissue necrosis, although the flaps experienced a significant decrease of cutaneous oxygenation.
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12
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Osseointegrated Finger Prostheses Using a Tripod Titanium Mini-Plate. Arch Plast Surg 2017; 44:150-156. [PMID: 28352604 PMCID: PMC5366522 DOI: 10.5999/aps.2017.44.2.150] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2016] [Revised: 09/15/2016] [Accepted: 10/18/2016] [Indexed: 11/14/2022] Open
Abstract
Background Digital amputation is a common upper extremity injury and can cause significant impairment in hand function, as well as psychosocial stigma. Currently, the gold standard for the reconstruction of such injuries involves autologous reconstruction. However, when this or other autologous options are not available, prosthetic reconstruction can provide a functionally and aesthetically viable alternative. This study describes a novel technique, known as a tripod titanium mini-plate, for osseointegrated digit prostheses, and reviews the outcomes in a set of consecutive patients. Methods A retrospective review of patients who underwent 2-stage prosthetic reconstruction of digit amputations was performed. Demographic information, occupation, mechanism of injury, number of amputated fingers, and level of amputation were reviewed. Functional and aesthetic outcomes were assessed using the quick disabilities of the arm, shoulder, and hand (Q-DASH) scale and a visual analog scale (VAS) score, respectively. In addition, complications during the postoperative period were recorded. Results Seven patients were included in this study. Their average age was 29 years. Five patients had single-digit amputations and 2 patients had multiple-digit amputations. Functional and aesthetic outcomes were assessed using the Q-DASH score (average, 10.4) and VAS score (average, 9.1), respectively. One episode of mild cellulitis was seen at 24 months of follow-up. However, it was treated successfully with oral antibiotics. No other complications were reported. Conclusions When autologous reconstruction is not suitable for digit reconstruction, prosthetic osseointegrated reconstruction can provide good aesthetic and functional results. However, larger series with longer-term follow-up are required in order to rule out the possibility of other complications.
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Idrissi ME, Elibrahimi A, Shimi M, Elmrini A. [Digital replantation, results and complications: study of a series of 18 cases]. Pan Afr Med J 2016; 24:184. [PMID: 27795781 PMCID: PMC5072882 DOI: 10.11604/pamj.2016.24.184.8718] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2015] [Accepted: 04/03/2016] [Indexed: 11/11/2022] Open
Abstract
Digital amputations are frequent injuries, the majority of them are caused by workplace accidents. Microsurgical techniques are an alternative option to repair these amputations. This study aims to report our experience in digital replantation through the examination of 18 cases. We conducted a retrospective study of 14 patients with total or subtotal fingers amputation between June 2013 and January 2015. All unidigital and multidigital replantations downstream of the distal insertion of superficial flexor tendon as well as all digital replantations upstream of the distal insertion of superficial flexor tendon were included in our study. These patients underwent surgery according to conventional digital replantation procedures. Five replantations were secondarily regularized. Among the 18 replantations, eight digital replantions evolved favorably since replantation helped restore active range of motion and passive range of motion of the finger operated without revision surgery and early and late secondary complication. In our study we achieved satisfactory results despite the difficult conditions including the initial state of the amputated finger and its delayed management. The development and mastery of microsurgery has helped change the prognosis of these amputations with serious functional and psychological consequences; the results of our study are encouraging with reference to the implementation of the SOS Hand Service in Morocco.
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Affiliation(s)
| | | | - Mohammed Shimi
- Service de Chirurgie Ostéoarticulaire B4, CHU Hassan II, Fez, Maroc
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14
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Kusnezov N, Dunn JC, Stewart J, Mitchell JS, Pirela-Cruz M. Acute Limb Shortening for Major Near and Complete Upper Extremity Amputations with Associated Neurovascular Injury: A Review of the Literature. Orthop Surg 2016; 7:306-16. [PMID: 26792651 DOI: 10.1111/os.12213] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2015] [Accepted: 09/14/2015] [Indexed: 01/09/2023] Open
Abstract
In the setting a near or complete upper extremity amputations with significant soft tissue loss and neurovascular compromise, upper extremity surgeons are faced with the challenge of limb salvage. There are a multitude of treatment options for managing skeletal and soft tissue injuries including provisional fixation, staged reconstruction, and an acute shortening osteotomy with primary rigid internal fixation. However, many complications are associated with these techniques. Complications of provisional fixation include pin tract infection and loosening, tethering of musculotendinous units, nonunion, and additional surgeries. Staged reconstruction includes a variety of techniques: distraction osteogenesis, bone transport, or vascularized and non-vascularized structural autograft or allograft, but the risks often outweigh the benefits. Risks include nonunion, postoperative vascular complications necessitating reoperation, and the inability to return to the previous level of function at an average of 24 months. Acute shortening osteotomy with internal fixation offers the advantage of a single-stage procedure that provides for decreasing the soft tissue loss, provides a rigid platform to protect the delicate neurovascular repair, and alleviates unwanted tension at the repair sites. This review discusses the literature on the surgical treatment of severe upper extremity trauma with associated neurovascular injury over the past 75 years, and aims to evaluate the indications, surgical techniques, clinical and functional outcomes, and complications associated with acute shortening osteotomy with rigid internal fixation. Although this technique is not without risks, it is well-tolerated in the acute setting with a complication profile comparable to other techniques of fixation while remaining a single procedure.
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Affiliation(s)
- Nicholas Kusnezov
- Department of Orthopaedic Surgery and Rehabilitation, Texas Tech University Health Sciences Center El Paso, El Paso, Texas, USA
| | - John C Dunn
- Department of Orthopaedic Surgery and Rehabilitation, Texas Tech University Health Sciences Center El Paso, El Paso, Texas, USA
| | - Jeremy Stewart
- Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center El Paso, El Paso, Texas, USA
| | - Justin S Mitchell
- Department of Orthopaedic Surgery and Rehabilitation, Beaumont Army Medical Center, El Paso, Texas, USA
| | - Miguel Pirela-Cruz
- Department of Orthopaedic Surgery and Rehabilitation, Texas Tech University Health Sciences Center El Paso, El Paso, Texas, USA
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15
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Breahna A, Siddiqui A, Fitzgerald O'Connor E, Iwuagwu FC. Replantation of digits: a review of predictive factors for survival. J Hand Surg Eur Vol 2016; 41:753-7. [PMID: 26763268 DOI: 10.1177/1753193415624663] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2015] [Accepted: 11/03/2015] [Indexed: 02/03/2023]
Abstract
UNLABELLED The survival of 75 consecutive digital replantations carried out between 2006 and 2010 at a regional hand centre in the United Kingdom was determined. The patient demographics, mechanism of injury, co-morbid factors, operative and post-operative details were extracted and reviewed from the medical and hand therapy notes. Predictive factors of survival were determined by using univariate and multivariate statistical analysis. The survival rate was 70%. Arterial thrombosis was the leading cause of replant failure, followed by venous congestion. Smoking, level of amputation, number of nerves repaired, warm ischaemia time and timing of replantation were independent predictors of replant survival. However, only warm ischaemia time less than 6 hours and 30 minutes and replantations done within 'office hours' showed significance on multivariate logistic regression. Our study suggests that replantations done in daylight hours, when feasible, with rested staff and a full complement of the theatre team are likely to have better outcomes. LEVEL OF EVIDENCE Level IV case series.
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Affiliation(s)
- A Breahna
- St Andrew's Centre for Plastic Surgery and Burns, Broomfield Hospital, Chelmsford, UK
| | - A Siddiqui
- St Andrew's Centre for Plastic Surgery and Burns, Broomfield Hospital, Chelmsford, UK
| | - E Fitzgerald O'Connor
- St Andrew's Centre for Plastic Surgery and Burns, Broomfield Hospital, Chelmsford, UK
| | - F C Iwuagwu
- St Andrew's Centre for Plastic Surgery and Burns, Broomfield Hospital, Chelmsford, UK
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Prsic A, McGregor A. Man With Finger Injury. Ann Emerg Med 2016; 67:e9-e10. [PMID: 26915559 DOI: 10.1016/j.annemergmed.2015.08.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2015] [Indexed: 11/16/2022]
Affiliation(s)
- Adnan Prsic
- Department of Plastic and Reconstructive Surgery, The Alpert Medical School of Brown University and Rhode Island Hospital, Providence, RI
| | - Alyson McGregor
- Department of Emergency Medicine, The Alpert Medical School of Brown University and Rhode Island Hospital, Providence, RI
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Sun YF, Fang QX, Zhan HY, Wang F, Cao W, Zhao G. Outcome Assessments of Patients with Posttraumatic "Ultra-Time Vascular Injuries" of the Extremities. Sci Rep 2015; 5:17913. [PMID: 26639214 PMCID: PMC4671146 DOI: 10.1038/srep17913] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2015] [Accepted: 11/09/2015] [Indexed: 11/15/2022] Open
Abstract
The management of posttraumatic vascular injury that presents after 8 h, or “ultra-time vascular injury”, is daunting, and inciting recognition of this injury is vital. We retrospectively analyzed 29 patients with ultra-time vascular injuries to determine the patients’ demographic characteristics and identify the determinants for amputation and disability. The age distribution of the high-risk population was from 18 years to 40 years, which indicated that these patients had plenty of productive life remaining. Injuries to the lower limbs (79.31%) were over four times more common than injuries to the upper limbs (17.24%), and open and blunt injuries occurred most commonly. The overall rate of limb salvage was 82.76% (24/29) and limb function is excellent in 45.83% (11/24) of the patients. The remaining patients experienced different degrees of disability in their limbs, which was determined by the anatomic location of the injury, and the presence of a combined arterial and venous injury, nerve injury, and complex soft tissue injury, as well as the occurrence of compartment syndrome. Hence, we recommend limb-salvage treatment for patients with traumatic ultra-time vascular injuries, particularly for those aged between 18 years and 40 years. Furthermore, we encourage the development of limb-salvage techniques for ultra-time vascular injuries.
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Affiliation(s)
- Yi-Feng Sun
- Traumatology Department of Shandong Provincial Qianfoshan Hospital, Shandong University, Jingshi Road 16766, Jinan, Shandong 250014, PR China
| | - Qiong-Xuan Fang
- Liver Disease Department of the Second Hospital of Shandong University (SHSU), Beiyuan Road 247, Jinan, Shandong 250033, PR China
| | - Hong-Yan Zhan
- The Fourth Hospital of Jinan city, Jinan, Shandong, 250031, PR China
| | - Fan Wang
- Traumatology Department of Shandong Provincial Qianfoshan Hospital, Shandong University, Jingshi Road 16766, Jinan, Shandong 250014, PR China
| | - Wei Cao
- Traumatology Department of Shandong Provincial Qianfoshan Hospital, Shandong University, Jingshi Road 16766, Jinan, Shandong 250014, PR China
| | - Gang Zhao
- Traumatology Department of Shandong Provincial Qianfoshan Hospital, Shandong University, Jingshi Road 16766, Jinan, Shandong 250014, PR China
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Shen LJ, Chen YQ, Cheng D, Zhang C, Jiang L, Hong M, Kang QY. In VivoRetinal Vein Bypass Surgery in a Porcine Model. Curr Eye Res 2014; 41:79-87. [DOI: 10.3109/02713683.2014.997887] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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