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The Journal of Thoracic and... Jan 2022
Topics: Aortic Valve; Bicuspid Aortic Valve Disease; Cardiac Valve Annuloplasty; Humans; Long Term Adverse Effects; Organ Sparing Treatments; Outcome and Process Assessment, Health Care; Postoperative Complications; Reoperation; Replantation; Survival Analysis
PubMed: 32684392
DOI: 10.1016/j.jtcvs.2020.02.148 -
Journal of Vascular Surgery Feb 2020
Topics: Aortic Aneurysm, Abdominal; Colitis, Ischemic; Humans; Mesenteric Artery, Inferior; Replantation
PubMed: 32040438
DOI: 10.1016/j.jvs.2019.09.027 -
Clinics in Plastic Surgery Jul 2019The literature on surgical techniques and recent evidence in microsurgical digital and hand replantation is reviewed. Replantation should not be done routinely without... (Review)
Review
The literature on surgical techniques and recent evidence in microsurgical digital and hand replantation is reviewed. Replantation should not be done routinely without considering postoperative functional outcomes. Achieving best outcomes is related to the success of microvascular anastomosis and to adequacy of bone fixation, tendon and nerve repair, and soft-tissue coverage. Replantation surgery has become a routine procedure. However, little is known about the decision-making process for digital and hand amputation. A study comparing the outcomes of digital and hand amputations treated with replantation or revision amputation is needed. Outcome assessment includes not only function but also patient-reported outcomes.
Topics: Amputation, Traumatic; Contraindications, Procedure; Finger Injuries; Fingers; Hand; Hand Injuries; Humans; Reoperation; Replantation
PubMed: 31103081
DOI: 10.1016/j.cps.2019.03.002 -
JAMA Network Open Sep 2022Recent evidence suggests that select delayed replantation may not adversely affect digit survival; however, whether surgical timing (overnight or daytime) is associated...
IMPORTANCE
Recent evidence suggests that select delayed replantation may not adversely affect digit survival; however, whether surgical timing (overnight or daytime) is associated with digit replantation outcomes is unknown.
OBJECTIVE
To assess whether digit survival, complication rate, and duration of surgery are associated with time of replantation.
DESIGN, SETTING, AND PARTICIPANTS
This retrospective case series study included all replantations performed at a single tertiary referral academic center between January 1, 2000, and August 1, 2021. Data were analyzed between October 2, 2021, and January 1, 2022. Four daytime surgery intervals were selected based on literature review. Daytime replantations started within the intervals whereas overnight replantations began outside the intervals. For each case, the procedure difficulty score and the attending surgeon expertise score were calculated. Logistic and linear regressions adjusting for confounders including procedure difficulty score and expertise score were used to assess surgical timing and outcomes. Participants were adults (aged ≥18 years) undergoing digit replantations between January 2000 and August 2021 with at least 1-month follow-up. Replantation was defined as the reattachment of a completely amputated digit that necessitated anastomosis of both artery and vein.
EXPOSURES
Daytime or overnight digit replantation.
MAIN OUTCOMES AND MEASURES
Viable replanted digit at 1-month follow-up, number of complications, and duration of surgery.
RESULTS
A total of 98 patients (mean [SD] age, 39.5 [15.3] years; 136 [93%] men) and 147 digits met inclusion criteria. Overall success rate was 55%. Between 4 pm and 7 am, overnight replantations were associated with 0.4 fewer complications (β, -0.4; 95% CI, -0.8 to -0.1) and 90.7 minutes shorter operative time (β, -90.7; 95% CI, -173.6 to -7.7). A 1-point increase in surgeon expertise score was associated with 1.7 times increased odds of replantation success for all intervals (adjusted odds ratio, 1.7; 95% CI, 1.2 to 2.4; P = .002). There were no differences in digit survival by surgical time.
CONCLUSIONS AND RELEVANCE
In this case series study of digit replantations, time of operation was not associated with replantation success. Overnight replantation was associated with fewer complications and shorter duration of surgery compared with daytime surgery. Results of this study suggest that overnight replantations may be performed with outcomes comparable to daytime replantations at a tertiary care academic center.
Topics: Adolescent; Adult; Amputation, Traumatic; Female; Finger Injuries; Humans; Male; Replantation; Retrospective Studies; Treatment Outcome
PubMed: 36048443
DOI: 10.1001/jamanetworkopen.2022.29526 -
The Journal of Thoracic and... Jul 2019
Topics: Aorta; Aortic Valve; Bicuspid; Humans; Replantation; Tricuspid Valve
PubMed: 31248515
DOI: 10.1016/j.jtcvs.2018.10.158 -
Ulusal Travma Ve Acil Cerrahi Dergisi =... Jan 2020Upper extremity amputations are usually not life-threatening, but they negatively affect the life quality of the victim. In addition to the functional disabilities of... (Review)
Review
BACKGROUND
Upper extremity amputations are usually not life-threatening, but they negatively affect the life quality of the victim. In addition to the functional disabilities of upper extremity amputation, disfigurements frequently cause psychological and social debilitations.
METHODS
Between 2007-2015, fourteen cases were admitted to emergency with total major amputation of the upper extremity. All cases were male (22-45 years of age. Mean age: 29.6). Replantation was applied to all except three cases with multileveled crush injuries.
RESULTS
All replantations were successful. Additional interventions were needed in four cases with replantation at elbow level and replantation at the distal arm level. The postoperative functional results were evaluated. The patient's overall satisfaction, the recovery of flexor and extensor mobility, the extent of the active motion of digits, the recovery of thumb opposition, active movements of wrist and elbow joints, recovery of sensitivity in the median and ulnar nerve, the ability of the surviving hand and/or forearm to perform daily works are all evaluated. The results were satisfactory in hand replantations. However, some ulnar nerve distal motor problems were encountered in three cases with replantation at elbow level, and one case with replantation at the distal arm level with a crush injury, acceptable and excellent results were obtained in other cases.
CONCLUSION
Despite the availability of prostheses, cadaveric upper extremity replantations, replantation of the native extremity is still the most appropriate treatment for amputated cases. However, surgeons should realize that the ultimate goal is not merely to save the viability of the extremity through replantation, but rather to preserve the life quality by improving the function.
Topics: Adult; Amputation, Traumatic; Humans; Male; Middle Aged; Replantation; Upper Extremity; Young Adult
PubMed: 31942747
DOI: 10.14744/tjtes.2019.85787 -
The Journal of Thoracic and... May 2020
Topics: Aorta; Cardiac Surgical Procedures; Replantation
PubMed: 31279512
DOI: 10.1016/j.jtcvs.2019.06.005 -
The Journal of Thoracic and... Mar 2021
Topics: Aortic Dissection; Dissection; Humans; Replantation; Research
PubMed: 33353750
DOI: 10.1016/j.jtcvs.2020.11.084 -
The Journal of Thoracic and... Aug 2019
Topics: Aortic Dissection; Aortic Diseases; Dilatation; Humans; Replantation; Tunica Intima
PubMed: 30446278
DOI: 10.1016/j.jtcvs.2018.10.019 -
Journal of Plastic, Reconstructive &... Nov 2022Foot injuries due to vehicular or other accidents are common. However, complete toe amputation is rare. This study explored the current protocols and clinical... (Review)
Review
BACKGROUND
Foot injuries due to vehicular or other accidents are common. However, complete toe amputation is rare. This study explored the current protocols and clinical significance of toe replantation.
METHODS
From December 2011 to December 2018, ten patients with 13 severed toes underwent toe replantation in our hospital. Seven cases were replanted antegrade, and three cases were replanted retrograde.
RESULTS
All patients were followed for two to three years after toe replantation. One big toe underwent necrosis, while the other 12 toes survived completely. The appearance and feel of the successfully replanted toes were satisfactory, and the patients exhibited a normal gait.
CONCLUSION
Toe replantation can achieve an acceptable appearance and function of the foot and considerably reduce the psychological effects experienced by the patients. Increased clinical attention and application of toe replantation are needed.
LEVEL OF EVIDENCE
Level IV, retrospective case series.
Topics: Humans; Amputation, Traumatic; Retrospective Studies; Replantation; Toes; Hallux; Microsurgery; Finger Injuries
PubMed: 36207234
DOI: 10.1016/j.bjps.2022.08.050