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The Journal of Thoracic and... Apr 2018
Topics: Animals; Aortic Aneurysm, Thoracic; Replantation; Snakes
PubMed: 29397967
DOI: 10.1016/j.jtcvs.2017.12.034 -
The Journal of Thoracic and... May 2017
Topics: Mitral Valve; Replantation
PubMed: 28411746
DOI: 10.1016/j.jtcvs.2017.02.028 -
Plastic and Reconstructive Surgery Sep 2011The aim of this study was to conduct a systematic review of the English literature on replantation of distal digital amputations to provide the best evidence of survival... (Review)
Review
BACKGROUND
The aim of this study was to conduct a systematic review of the English literature on replantation of distal digital amputations to provide the best evidence of survival rates and functional outcomes.
METHODS
A MEDLINE search using "digit," "finger," "thumb," and "replantation" as keywords and limited to humans and English-language articles identified 1297 studies. Studies were included in the review if they (1) present primary data, (2) report five or more single or multiple distal replantations, and (3) present survival rates. Additional data extracted from the studies meeting the inclusion criteria included demographic information, nature and level of amputation, venous outflow technique, nerve repair, recovery of sensibility, range of motion, return to work, and complications.
RESULTS
Thirty studies representing 2273 distal replantations met the inclusion criteria. The mean survival rate was 86 percent. There was no difference in survival between zone I and zone II replantations (Tamai classification). There was a significant difference in survival between replantation of clean-cut versus the more crushed amputations (crush-cut and crush-avulsion). The repair of a vein improved survival in both zone I and zone II replantation. The mean two-point discrimination was 7 mm (n = 220), and 98 percent returned to work (n = 98). Complications included pulp atrophy in 14 percent of patients (n = 639) and nail deformity in 23 percent (n = 653).
CONCLUSIONS
The common perception that distal replantation is associated with little functional gain is not based on scientific evidence. This systematic review showed a high success rate and good functional outcomes following distal digital replantation.
CLINICAL QUESTION/LEVEL OF EVIDENCE
Therapeutic, IV.
Topics: Adult; Amputation, Traumatic; Child; Female; Finger Injuries; Humans; Male; Middle Aged; Postoperative Complications; Replantation; Thumb; Treatment Outcome
PubMed: 21572379
DOI: 10.1097/PRS.0b013e318221dc83 -
Urology Journal 2007Penile amputation is a rare urologic condition for which immediate surgical replantation is warranted. The surgical technique used for repair has been modified and... (Review)
Review
INTRODUCTION
Penile amputation is a rare urologic condition for which immediate surgical replantation is warranted. The surgical technique used for repair has been modified and refined. Our aim was to assess the effects of several interventions and management for amputated penis after replantation.
MATERIALS AND METHODS
We searched the MEDLINE (January 1966 to May 2007), EMBASE (January 1988 to January 2007), CINAHL (January 1982 to January 2007), PsycLIT (January 1984 to January 2007), ERIC (January 1984 to January 2007), and the bibliographic data of relevant articles; hand-searched conference proceedings; and contacted investigators to locate studies. All reported cases of penile replantation were studied. We assessed all titles, abstracts, and extracted data from the articles identified for inclusion. Outcome measures included cosmetic outcomes, acceptability, operative time, restoration of erectile function, sensibility of the glans, and long-term outcomes.
RESULTS
Eighty patients had undergone penile replantation. There was considerable variation in the interventions, patients, and outcome measures. The majority of the reported cases in this area continue to be of moderate quality, although more recent cases have been of higher quality in terms of both patients' demographics and surgical techniques. Data were not available in all of the cases for many of the outcomes expected to be reported. There were several important variations in the cases studied.
CONCLUSION
The value of the various microsurgical techniques for replantation of the penis remains uncertain. Meticulous microsurgical techniques by experienced surgeons can reduce skin, urethra, and graft loss complications and produce a functional organ; nonetheless, such complications are still highly prevalent.
Topics: Humans; Male; Penis; Replantation
PubMed: 17701923
DOI: No ID Found -
The Journal of Thoracic and... Jan 2019
Topics: Endocarditis; Humans; Pulmonary Valve; Replantation
PubMed: 30297089
DOI: 10.1016/j.jtcvs.2018.08.074 -
European Journal of Trauma and... Aug 2022Traumatic mutilation of major limbs can result in limb loss, motor disability, or death. Patients who had replantation failure needed to undergo additional surgeries...
PURPOSE
Traumatic mutilation of major limbs can result in limb loss, motor disability, or death. Patients who had replantation failure needed to undergo additional surgeries (even amputation) and had a longer length of hospital stay. Here, we determined the risk and prognostic factors of replantation failure in patients with traumatic major limb mutilation.
METHODS
This retrospective study included adult inpatients with severed traumatic major limb mutilation who underwent replantation from Suzhou Ruixing Medical Group from October 18, 2016 to July 31, 2020. Demographic, and clinical characteristics including traumatic conditions, laboratory findings, mangled extremity severity scores (MESS), treatments, and outcomes of the patients were collected. Data were used to analyze predictors and risk factors for replantation failure.
RESULTS
Among the 66 patients, 48 (72.7%) were males, the median age was 47.0 years old. Replantation failure occurred in 48 patients (72.7%). The area under the curve of the joint prediction of lactic acid on admission, 72-h cumulative fluid balance, and albumin level immediately postoperatively was 0.838 (95% confidence interval [CI], 0.722-0.954; P < 0.001) with a sensitivity of 89.7% and a specificity of 69.2%. Lower limb trauma (odds ratio [OR] 8.65, 95% CI 1.64-45.56, P = 0.011), mangled extremity severity scores (OR 2.24, 95% CI 1.25-4.01, P = 0.007), and first 72-h cumulative fluid balance > 4885.6 mL (OR 10.25, 95% CI 1.37-76.93, P = 0.024) were independent risk factors for replantation failure.
CONCLUSIONS
Lower limb trauma, mangled extremity severity scores, and cumulative water balance were associated with replantation failure, implying that fluid management is necessary for major limb salvage. More studies are needed to explore the predictive power of indicators related to tissue oxygenation and wound healing for replantation failure.
Topics: Adult; Amputation, Surgical; Disabled Persons; Extremities; Female; Humans; Limb Salvage; Male; Middle Aged; Motor Disorders; Prognosis; Replantation; Retrospective Studies
PubMed: 35050386
DOI: 10.1007/s00068-021-01876-w -
JAMA Network Open Oct 2021Risk-adjusted variation in surgeon outcomes has been traditionally explained by surgeon volume and hospital infrastructure, yet it is unclear how a surgeon's operative...
IMPORTANCE
Risk-adjusted variation in surgeon outcomes has been traditionally explained by surgeon volume and hospital infrastructure, yet it is unclear how a surgeon's operative proficiency directly contributes to their patients' outcomes.
OBJECTIVE
To assess the variation of surgeons' operative proficiency and investigate its association with surgical outcomes.
DESIGN, SETTING, AND PARTICIPANTS
This case series was a retrospective analysis of all digit replantations and revascularizations at a single US university medical center between January 2000 and August 2020. Surgeons were assigned a proficiency score based on the expected procedure difficulty and outcomes from a sample of their cases. Surgeon proficiency scores were then used to determine associations with outcomes from subsequent cases. The expected difficulty of each case was calculated using a novel scoring system that applied pooled relative risks from a meta-analysis of risk factors for replantation and revascularization failure.
EXPOSURES
Digit replantation and revascularization.
MAIN OUTCOMES AND MEASURES
Digit survival at 1-month follow up (case success) and number of complications.
RESULTS
A total of 145 patients and 226 digits were treated by 11 surgeons with training in hand or microsurgery (mean [SD] age, 41.9 [15.2] years; 204 [90%] men); there were 116 replantations and 110 revascularizations. Surgeon proficiency scores ranged from 1.3 to 5.7, with a mean (SD) of 3.4 (1.4). Case success rates among surgeons varied from 20.0% to 90.5%, with a mean (SD) of 64.9%. Higher proficiency scores were associated with fewer case failures: each point increase was associated with 40% decreased odds of failure (odds ratio, 0.60; 95% CI, 0.38-0.94). Every 3-point increase in proficiency score was associated with 1 less complication (effect estimate, -0.29; 95% CI, -0.56 to 0.02). Surgeon proficiency score had a greater association with case failure than surgeon volume (16.7% vs 12.0%). The final model's association with case failure had an area under the receiver operating characteristics curve of 0.93.
CONCLUSIONS AND RELEVANCE
Operative proficiency varied widely among practicing surgeons and accounted for 17% of estimative ability for success of digit replantation and revascularization. Greater surgeon proficiency was associated with better outcomes, indicating that the value of surgical care may be optimized by improving surgeon proficiency.
Topics: Adult; Amputation, Surgical; Clinical Competence; Female; Fingers; Humans; Logistic Models; Male; Middle Aged; Odds Ratio; Propensity Score; Replantation; Retrospective Studies; Surgeons; Treatment Outcome
PubMed: 34698849
DOI: 10.1001/jamanetworkopen.2021.28765 -
The Journal of Thoracic and... Jun 2018
Topics: Aorta; Aortic Valve; Humans; Replantation
PubMed: 29501232
DOI: 10.1016/j.jtcvs.2018.01.065 -
Investigative and Clinical Urology Jan 2017The da Vinci robotic system has improved surgeon dexterity, ergonomics, and visualization to allow for a minimally invasive option for complex reconstructive procedures... (Review)
Review
The da Vinci robotic system has improved surgeon dexterity, ergonomics, and visualization to allow for a minimally invasive option for complex reconstructive procedures in children. Over the past decade, robot-assisted laparoscopic ureteral reimplantation (RALUR) has become a viable minimally invasive surgical option for pediatric vesicoureteral reflux (VUR). However, higher-than-expected complication rates and suboptimal reflux resolution rates at some centers have also been reported. The heterogeneity of surgical outcomes may arise from the inherent and underestimated complexity of the RALUR procedure that may justify its reclassification as a complex reconstructive procedure and especially for robotic surgeons early in their learning curve. Currently, no consensus exists on the role of RALUR for the surgical management of VUR. High success rates and low major complication rates are the expected norm for the current gold standard surgical option of open ureteral reimplantation. Similar to how robot-assisted laparoscopic surgery has gradually replaced open surgery as the most utilized option for prostatectomy in prostate cancer patients, RALUR may become a higher utilized surgical option in children with VUR if the adoption of standardized surgical techniques that have been associated with optimal outcomes can be adopted during the second decade of RALUR. A future standard of RALUR for children with VUR whose parents seek a minimally invasive surgical option can arise if widespread achievement of high success rates and low major complication rates can be obtained, similar to the replacement of open surgery with robot-assisted laparoscopic radical prostectomy as the new strandard for men with prostate cancer.
Topics: Adolescent; Child; Child, Preschool; Humans; Infant; Infant, Newborn; Replantation; Robotic Surgical Procedures; Treatment Outcome; Ureter; Vesico-Ureteral Reflux
PubMed: 28097262
DOI: 10.4111/icu.2017.58.1.3 -
The Journal of Hand Surgery Apr 2011Recent studies presenting functional outcomes after replantation of finger avulsion injuries have challenged the historical practice of performing revision amputation... (Review)
Review
PURPOSE
Recent studies presenting functional outcomes after replantation of finger avulsion injuries have challenged the historical practice of performing revision amputation for all complete finger avulsion injuries. The aim of this study is to conduct a systematic review of the English literature of replantation of finger avulsion injuries to provide best evidence of survival rates and functional outcomes.
METHODS
A Medline literature search yielded 1,398 studies, using key words "traumatic amputation" or "replantation", with limitation to humans and finger injuries. Inclusion criteria required that studies meet the following requirements: (1) primary data are presented; (2) the study includes at least 5 cases with either complete or incomplete finger avulsion injuries at or distal to the metacarpophalangeal joint; (3) the study presents survival rates, total active arc of motion (TAM), or static 2-point discrimination (2PD) data; (4) data for incomplete and complete avulsions are reported separately; (5) patients are treated with microvascular revascularization or replantation. Survival rates, TAM, and 2PD data were recorded and a weighted mean of each was calculated.
RESULTS
Thirty-two studies met the inclusion criteria. Of these 32 studies, all reported survival outcomes, 13 studies reported TAM (metacarpophalangeal, proximal interphalangeal, and distal interphalangeal), and 9 studies reported sensibility. The mean survival rate for complete finger and thumb avulsions having replantation was 66% (n = 442). The mean TAM of complete finger avulsions after successful replantation was 174° (n = 75), with a large number of patients in the included studies having arthrodesis of the distal interphalangeal joint. The mean 2PD in patients after replantation was 10 mm (n = 32).
CONCLUSIONS
We found that functional outcomes of sensibility and range of motion after replantation of finger avulsion injuries are better than what is historically cited in the literature. The results of this systematic review challenge the practice of performing routine revision amputation of all complete finger avulsion injuries.
Topics: Amputation, Traumatic; Female; Finger Injuries; Fingers; Graft Survival; Humans; Male; Microcirculation; Microsurgery; Postoperative Complications; Prognosis; Range of Motion, Articular; Recovery of Function; Regional Blood Flow; Replantation; Risk Assessment; Treatment Outcome; Wound Healing
PubMed: 21463730
DOI: 10.1016/j.jhsa.2010.12.023