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Moltaji S, Gallo M, Wong C, Murphy J, Gallo L, Waltho D, Copeland A, Karpinski M, Mowakket S, Duku E, Thoma A. Reporting Outcomes and Outcome Measures in Digital Replantation: A Systematic Review. J Hand Microsurg 2020; 12:85-94. [PMID: 33335363 PMCID: PMC7735551 DOI: 10.1055/s-0040-1701324] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Introduction There is a lack of consensus on what the critical outcomes in replantation are and how best to measure them. This review aims to identify all reported outcomes and respective outcome measures used in digital replantation. Materials and Methods Randomized controlled trials, cohort studies, and single-arm observational studies of adults undergoing replantation with at least one well-described outcome or outcome measure were identified. Primary outcomes were classified into six domains, and outcome measures were classified into eight domains. The clinimetric properties were identified and reported. A total of 56 observational studies met the inclusion criteria. Results In total, 29 continuous and 29 categorical outcomes were identified, and 87 scales and instruments were identified. The most frequently used outcomes were survival of replanted digit, sensation, and time in hospital. Outcomes and measures were most variable in domains of viability, quality of life, and motor function. Only eight measures used across these domains were validated and proven reliable. Conclusion Lack of consensus creates an obstacle to reporting, understanding, and comparing the effectiveness of various replantation strategies.
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Affiliation(s)
- Syena Moltaji
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Matteo Gallo
- Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Chloe Wong
- Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Jessica Murphy
- Division of Plastic Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Lucas Gallo
- Division of Plastic Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Daniel Waltho
- Division of Plastic Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Andrea Copeland
- Division of Plastic Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Marta Karpinski
- Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Sadek Mowakket
- Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Eric Duku
- Department of Psychiatry and Behavioral Neurosciences, McMaster University, Hamilton, Ontario, Canada
| | - Achilleas Thoma
- Division of Plastic Surgery, McMaster University, Hamilton, Ontario, Canada
- Department of Surgery, McMaster University, Hamilton, Ontario, Canada
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
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A new pathway to classification of complex hand injuries: a clinical pilot testing using a new method of assessment. Arch Orthop Trauma Surg 2012; 132:1343-51. [PMID: 22648321 DOI: 10.1007/s00402-012-1549-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2011] [Indexed: 10/27/2022]
Abstract
All existing classifications, which are based on the severity of hand injuries, are being referred to facets of variety of hand injuries in general. A clear picture of all consequences of hand injuries would be apparent, if any kind of injury mechanism and occurrence of an injury would be identified and academically captured. Predictions regarding return to the former occupation and rehabilitation time would be possible with further study; 102 patients with different hand injuries were engaged in a pilot project using a specifically designed assessment sheet to achieve this purpose in the framework of a retrospective clinical testing within 1 year. Data were summarized and demonstrated graphically. Each category showed a picture of prior localization of the injury and its morphology. All categories show specific injury patterns. The choice of categories reflects the mechanisms of injury emphasized in literature. Furthermore, the mean DASH equivalents of one category were compared to the mean Hand Injury Severity Scoring (HISS) scores in order to get an initial idea of information on the degree of severity. A first impression of the potential of this assessment sheet has been obtained with regard to the above. With further study, we could evaluate the assessment sheet and try to create a classification of the grade of severity as well as prognostic values like return to the former occupation and rehabilitation time.
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Abstract
INTRODUCTION Hand injuries are common and costly. The need for hand surgery specialists is undeniable. In the state of Florida, the availability of specialty services in hand surgery is limited. Florida ranks 4th in population and 32nd in hand surgeons per 100,000 state residents. Recent media reports highlight these limitations among hand surgeons and other specialists in the state. METHODS To evaluate the need for hand surgery centers of excellence in the state, we performed a retrospective review of data collected from the Agency for Health Care Administration database of hospital inpatient admissions from 1997 to the second quarter of 2007. Demographic information, details of the injury, and outcome data were evaluated in patients with amputation injuries. Amputations of the thumb, fingers, and hand/wrist/forearm were counted and factors associated with these injuries were recorded. Place of occurrence and injuries caused by machinery were evaluated. A regression analysis was performed to evaluate trends in the number of amputations and replantation procedures. RESULTS We identified 4,858 patients with amputations in this time period. There were approximately 462 amputations per year. The trend in finger amputations appeared to be increasing yearly, whereas the trend for replantation surgery was decreasing. Six percent of the hospitals recording admissions with the Agency for Health Care Administration performed 68% of the replantation surgeries in the state. We also noted an increasing proportion of patients being admitted and treated outside of their own county and region. CONCLUSION With fewer replantation surgeries performed and patients traveling farther for treatment we conclude that there is a need for coordinated evaluation, triage and treatment of patients with hand injuries requiring specialized hand surgery services at centers of excellence in Florida.
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Rosson GD, Buncke GM, Buncke HJ. Great toe transplant versus thumb replant for isolated thumb amputation: critical analysis of functional outcome. Microsurgery 2009; 28:598-605. [PMID: 18846572 DOI: 10.1002/micr.20549] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Thumb replantation following thumb amputation is the standard of care. When replantation is impossible, microneurovascular great toe transplantation is a well-established option. METHODS A retrospective review was conducted to evaluate functional outcome following isolated thumb replantation or great toe transplantation for thumb reconstruction. From 1974 to 1993, 384 thumb amputations were treated and 110 great toe-to-thumb transplantations were performed. RESULTS Ninety-one patients with isolated thumb amputation had an 85% survival rate. Failed replants usually resulted from crushing or avulsing injuries. Function of replanted thumbs was better in sharp compared with crush/avulsion injuries. Forty-three isolated thumb reconstructions had a 93% success rate. Function was comparable with thumb replants from sharp injuries. Interphalangeal motion was significantly better in great toe transplants than in replanted thumbs of the crush/avulsion type. CONCLUSIONS Amputated thumbs should be replanted. When replantation is not possible or unsuccessful, a transplanted great toe functions as well as, or better than, a replanted thumb.
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Affiliation(s)
- Gedge D Rosson
- Division of Plastic Surgery, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA.
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Abstract
Limited access to hand surgical care in the emergency room appears to be a problem in north Florida and probably other parts of the country, as well. In this study, hand surgeons in 3 major cities were contacted to determine what on-call services they provide for hospital emergency departments in their areas. Additionally, hospitals that accept trauma patients were queried about how many hand surgeons they have on staff and if there were times when no surgeon was on call and how they managed hand trauma when that problem is encountered. Results showed that although there are numerous hand surgeons in each city, there were many times in which a hospital would have no hand surgeon on call for an emergency. Our data suggest that on a regionally selective basis, hospital emergency facilities are deficient with respect to the availability of appropriate specialists for those patients requiring emergency hand procedures.
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Affiliation(s)
- Hollis Caffee
- Division of Plastic Surgery, University of Florida, Gainesville, FL, USA.
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Abstract
The decision to replant a severed part is based on the numerous factors that influence survival of the part and the functional and aesthetic benefits gained from replanting. Not all amputees will benefit from or are candidates for replantation. The decision to proceed is therefore made by the surgeon who must consider the mechanism and extent of injury, the age of the patient, the presence of other medical or surgical conditions, the likely functional outcomes, and the patient's motivation to undergo a difficult procedure, which is followed by a lengthy recovery. This is a meta-analysis of the available studies that tracks the outcomes, based on 9 criteria, after the amputation of a total of 1803 digits in 1299 patients. By combining the data from numerous sources, a statistically significant picture emerges which may be used to educate patients and help guide the surgeon in the decision to replant.
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Affiliation(s)
- Wojciech Dec
- NYU School of Medicine, 545 First Avenue, Suite 7R, New York, NY, USA.
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Sagiv P, Shabat S, Mann M, Ashur H, Nyska M. Rehabilitation process and functional results of patients with amputated fingers. Plast Reconstr Surg 2002; 110:497-503; discussion 504-5. [PMID: 12142667 DOI: 10.1097/00006534-200208000-00020] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Digit amputation is a physical and psychological trauma that can influence the daily living of a person. The rehabilitation of patients with digit amputation is a complex process and should take into consideration all influencing factors, such as the functional, emotional, social, and professional profile of the patient. This study was conducted to evaluate the functional level of patients with amputated fingers and to understand the factors that influence their rehabilitation. Fifty patients (42 male and 8 female with an age ranging from 7 to 84 years) who had digit amputation(s) between January of 1990 and December of 1998 at the level of the metacarpus or distal to it and who had at least 6 months of follow-up were examined. The patients were divided into three different study groups: patients with distal amputation were compared with patients who had proximal amputation, patients with one finger amputation were compared with patients who had multiple finger amputations, and patients who suffered finger amputations caused by work-related accidents were compared with those who suffered amputations caused by other incidents. In addition, the time lapse from the amputation was checked as an influencing factor for different functional levels. The results showed that patients with distal amputation reached a higher motor and sensory functional level than patients with proximal amputation. Patients with one-finger amputation reached higher motor, sensory, and activities of daily living functional levels than patients with multiple amputations, and the level of motor and sensory function of patients with finger amputations caused by work-related accidents was lower than that of patients who suffered amputations in other incidents. Time was proven to be an important factor in the process of motor and emotional recovery.
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Affiliation(s)
- Paul Sagiv
- Orthopaedic Surgery Department, Unit of Hand Surgery, Sapir Medical Center, Kfar-Sava, Israel
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Abstract
Two hundred eighty articles related to microvascular transplants and replants published in The Journal of Hand Surgery over the past 25 years were reviewed. Every facet of microsurgery was covered. One hundred seventy-one articles are referenced and discussed under the following major categories: microvascular transplants, replants, nerve grafts, vein grafts, cold intolerance, vasospasm, monitoring, immediate reconstruction, and historical. Contributions were received from 37 countries and 175 authors or groups of authors.
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Affiliation(s)
- H J Buncke
- Microsurgical Replantation Transplantation Service, California Pacific Medical Center Davies Campus, San Francisco 94114, USA
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