Download PDF
J Hand Microsurg 2018; 10(02): 66-73
DOI: 10.1055/s-0038-1626689
Original Article
Thieme Medical and Scientific Publishers Private Ltd.

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

Ashkaun Shaterian
1   Department of Plastic Surgery, University of California, Irvine, Orange, California, United States
,
Ramin Rajaii
1   Department of Plastic Surgery, University of California, Irvine, Orange, California, United States
,
Melissa Kanack
1   Department of Plastic Surgery, University of California, Irvine, Orange, California, United States
,
Gregory R. D. Evans
1   Department of Plastic Surgery, University of California, Irvine, Orange, California, United States
,
Amber Leis
1   Department of Plastic Surgery, University of California, Irvine, Orange, California, United States
› Author Affiliations
Further Information

Publication History

Received: 01 October 2017

Accepted: 02 December 2017

Publication Date:
20 March 2018 (online)

    Permissions and Reprints

Abstract

Introduction 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.

Materials and Methods 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.

Results 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 (p < 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.

Conclusion 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.

Keywords

amputation - digit survival - microsurgical replantation
 

  • References

  • 1 Mahmoudi E, Swiatek PR, Chung KC, Ayanian JZ. Racial variation in treatment of traumatic finger/thumb amputation: a national comparative study of replantation and revision amputation. Plast Reconstr Surg 2016; 137 (03) 576e-585e
    CrossrefPubMedGoogle Scholar
  • 2 Tessler O, Bartow MJ, Tremblay-Champagne MP. et al. Long-term health-related quality of life outcomes in digital replantation versus revision amputation. J Reconstr Microsurg 2017; 33 (06) 446-451
    Article in Thieme ConnectPubMedGoogle Scholar
  • 3 Bhuvaneswar CG, Epstein LA, Stern TA. Reactions to amputation: recognition and treatment. Prim Care Companion J Clin Psychiatry 2007; 9 (04) 303-308
    CrossrefPubMedGoogle Scholar
  • 4 Mulders MA, Neuhaus V, Becker SJ, Lee SG, Ring DC. Replantation and revascularization vs. amputation in injured digits. Hand (NY) 2013; 8 (03) 267-273
    CrossrefPubMedGoogle Scholar
  • 5 Cheng GL, Pan DD, Yang ZX, Qu ZY. Replantation of digits amputated at or about the distal interphalangeal joint. Ann Plast Surg 1985; 15 (06) 465-473
    CrossrefPubMedGoogle Scholar
  • 6 Yu H, Wei L, Liang B, Hou S, Wang J, Yang Y. Nonsurgical factors of digital replantation and survival rate: a metaanalysis. Indian J Orthop 2015; 49 (03) 265-271
    CrossrefPubMedGoogle Scholar
  • 7 Ma Z, Guo F, Qi J, Xiang W, Zhang J. Effects of non-surgical factors on digital replantation survival rate: a meta-analysis. J Hand Surg Eur Vol 2016; 41 (02) 157-163
    Google Scholar
  • 8 Sharma S, Lin S, Panozzo A, Tepper R, Friedman D. Thumb replantation: a retrospective review of 103 cases. Ann Plast Surg 2005; 55 (04) 352-356
    CrossrefPubMedGoogle Scholar
  • 9 Zhong-Wei C, Meyer VE, Kleinert HE, Beasley RW. Present indications and contraindications for replantation as reflected by long-term functional results. Orthop Clin North Am 1981; 12 (04) 849-870
    CrossrefPubMedGoogle Scholar
  • 10 Sebastin SJ, Chung KC. A systematic review of the outcomes of replantation of distal digital amputation. Plast Reconstr Surg 2011; 128 (03) 723-737
    CrossrefPubMedGoogle Scholar
  • 11 Moher D, Liberati A, Tetzlaff J, Altman DG, Group P. PRISMA Group. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Int J Surg 2010; 8 (05) 336-341
    CrossrefPubMedGoogle Scholar
  • 12 Adani R, Pataia E, Tarallo L, Mugnai R. Results of replantation of 33 ring avulsion amputations. J Hand Surg Am 2013; 38 (05) 947-956
    CrossrefPubMedGoogle Scholar
  • 13 Fufa D, Calfee R, Wall L, Zeng W, Goldfarb C. Digit replantation: experience of two U.S. academic level-I trauma centers. J Bone Joint Surg Am 2013; 95 (23) 2127-2134
    CrossrefPubMedGoogle Scholar
  • 14 Huang HF, Yeong EK. Surgical treatment of distal digit amputation: success in distal digit replantation is not dependent on venous anastomosis. Plast Reconstr Surg 2015; 135 (01) 174-178
    CrossrefPubMedGoogle Scholar
  • 15 Li J, Guo Z, Zhu Q. et al. Fingertip replantation: determinants of survival. Plast Reconstr Surg 2008; 122 (03) 833-839
    CrossrefPubMedGoogle Scholar
  • 16 Venkatramani H, Sabapathy SR. Fingertip replantation: technical considerations and outcome analysis of 24 consecutive fingertip replantations. Indian J Plast Surg 2011; 44 (02) 237-245
    CrossrefPubMedGoogle Scholar
  • 17 Baker GL, Kleinert JM. Digit replantation in infants and young children: determinants of survival. Plast Reconstr Surg 1994; 94 (01) 139-145
    CrossrefPubMedGoogle Scholar
  • 18 Matsuda M, Chikamatsu E, Shimizu Y. Correlation between number of anastomosed vessels and survival rate in finger replantation. J Reconstr Microsurg 1993; 9 (01) 1-4
    Article in Thieme ConnectPubMedGoogle Scholar
  • 19 Urbaniak JR, Roth JH, Nunley JA, Goldner RD, Koman LA. The results of replantation after amputation of a single finger. J Bone Joint Surg Am 1985; 67 (04) 611-619
    CrossrefPubMedGoogle Scholar
  • 20 Goldner RD, Stevanovic MV, Nunley JA, Urbaniak JR. Digital replantation at the level of the distal interphalangeal joint and the distal phalanx. J Hand Surg Am 1989; 14 (02) Pt 1 214-220
    CrossrefPubMedGoogle Scholar
  • 21 Hattori Y, Doi K, Ikeda K, Abe Y, Dhawan V. Significance of venous anastomosis in fingertip replantation. Plast Reconstr Surg 2003; 111 (03) 1151-1158
    CrossrefPubMedGoogle Scholar
  • 22 Yin F, Mi JY, Rui YJ. et al. [Risk factors of the failure in digit replantation]. Zhongguo Gu Shang 2015; 28 (05) 429-432
    PubMedGoogle Scholar
  • 23 Hirase Y. Salvage of fingertip amputated at nail level: new surgical principles and treatments. Ann Plast Surg 1997; 38 (02) 151-157
    CrossrefPubMedGoogle Scholar
  • 24 Koshima I, Yamashita S, Sugiyama N, Ushio S, Tsutsui T, Nanba Y. Successful delayed venous drainage in 16 consecutive distal phalangeal replantations. Plast Reconstr Surg 2005; 115 (01) 149-154
    PubMedGoogle Scholar
  • 25 Lin TS, Jeng SF, Chiang YC. Fingertip replantation using the subdermal pocket procedure. Plast Reconstr Surg 2004; 113 (01) 247-253
    CrossrefPubMedGoogle Scholar
  • 26 Ito H, Sasaki K, Morioka K, Nozaki M. Fingertip amputation salvage on arterial anastomosis alone: an investigation of its limitations. Ann Plast Surg 2010; 65 (03) 302-305
    CrossrefPubMedGoogle Scholar
  • 27 Malizos KN, Beris AE, Kabani CT, Korobilias AB, Mavrodontidis AN, Soucacos PN. Distal phalanx microsurgical replantation. Microsurgery 1994; 15 (07) 464-468
    CrossrefPubMedGoogle Scholar
  • 28 Chai Y, Kang Q, Yang Q, Zeng B. Replantation of amputated finger composite tissues with microvascular anastomosis. Microsurgery 2008; 28 (05) 314-320
    CrossrefPubMedGoogle Scholar
  • 29 Chen YC, Chan FC, Hsu CC, Lin YT, Chen CT, Lin CH. Fingertip replantation without venous anastomosis. Ann Plast Surg 2013; 70 (03) 284-288
    CrossrefPubMedGoogle Scholar
  • 30 Chen KK, Hsieh TY, Chang KP. Tamai zone I fingertip replantation: is external bleeding obligatory for survival of artery anastomosis-only replanted digits?. Microsurgery 2014; 34 (07) 535-539
    CrossrefPubMedGoogle Scholar
  • 31 Kim WK, Lim JH, Han SK. Fingertip replantations: clinical evaluation of 135 digits. Plast Reconstr Surg 1996; 98 (03) 470-476
    CrossrefPubMedGoogle Scholar
  • 32 Woo SH, Cheon HJ, Kim YW, Kang DH, Nam HJ. Delayed and suspended replantation for complete amputation of digits and hands. J Hand Surg Am 2015; 40 (05) 883-889
    CrossrefPubMedGoogle Scholar
  • 33 Breahna A, Siddiqui A, Fitzgerald O'ConnorE, Iwuagwu FC. Replantation of digits: a review of predictive factors for survival. J Hand Surg Eur Vol 2016; 41 (07) 753-757
    CrossrefPubMedGoogle Scholar
  • 34 Heistein JB, Cook PA. Factors affecting composite graft survival in digital tip amputations. Ann Plast Surg 2003; 50 (03) 299-303
    CrossrefPubMedGoogle Scholar
  • 35 Gordon L, Leitner DW, Buncke HJ, Alpert BS. Partial nail plate removal after digital replantation as an alternative method of venous drainage. J Hand Surg Am 1985; 10 (03) 360-364
    CrossrefPubMedGoogle Scholar
  • 36 Yamano Y. Replantation of fingertips. J Hand Surg [Br] 1993; 18 (02) 157-162
    CrossrefPubMedGoogle Scholar
  • 37 Lin CH, Aydyn N, Lin YT, Hsu CT, Lin CH, Yeh JT. Hand and finger replantation after protracted ischemia (more than 24 hours). Ann Plast Surg 2010; 64 (03) 286-290
    CrossrefPubMedGoogle Scholar
  • 38 Lee BI, Chung HY, Kim WK, Kim SW, Dhong ES. The effects of the number and ratio of repaired arteries and veins on the survival rate in digital replantation. Ann Plast Surg 2000; 44 (03) 288-294
    CrossrefPubMedGoogle Scholar
  • 39 Berlin NL, Tuggle CT, Thomson JG, Au A. Digit replantation in children: a nationwide analysis of outcomes and trends of 455 pediatric patients. Hand (NY) 2014; 9 (02) 244-252
    CrossrefPubMedGoogle Scholar
  • 40 Chia DS, Tay SC. A retrospective review of troubled replantations. Hand Surg 2015; 20 (01) 127-132
    CrossrefPubMedGoogle Scholar
  • 41 Zumiotti A, Ferreira MC. Replantation of digits: factors influencing survival and functional results. Microsurgery 1994; 15 (01) 18-21
    CrossrefPubMedGoogle Scholar
  • 42 Green DP, Wolfe SW. Green's Operative Hand Surgery. 6th ed.. Philadelphia, PA: Saunders/Elsevier; 2011: 1585-1603
    CrossrefGoogle Scholar
  • 43 Juri J, Irigaray A, Juri C, Grilli D, Blanco CM, Vazquez GD. Ear replantation. Plast Reconstr Surg 1987; 80 (03) 431-435
    CrossrefPubMedGoogle Scholar
  • 44 Nahai F, Hayhurst JW, Salibian AH. Microvascular surgery in avulsive trauma to the external ear. Clin Plast Surg 1978; 5 (03) 423-426
    CrossrefPubMedGoogle Scholar
  • 45 Baj A, Beltramini G, Laganà F, Bonanno V, De Riu G, Giannì A. Amputation trauma of the face: surgical techniques and microsurgical replantations. Acta Otorhinolaryngol Ital 2009; 29 (02) 92-96
    PubMedGoogle Scholar
  • 46 Morrison WA, McCombe D. Digital replantation. Hand Clin 2007; 23 (01) 1-12
    CrossrefPubMedGoogle Scholar
  • 47 Maricevich M, Carlsen B, Mardini S, Moran S. Upper extremity and digital replantation. Hand (NY) 2011; 6 (04) 356-363
    CrossrefPubMedGoogle Scholar
  • 48 Saies AD, Urbaniak JR, Nunley JA, Taras JS, Goldner RD, Fitch RD. Results after replantation and revascularization in the upper extremity in children. J Bone Joint Surg Am 1994; 76 (12) 1766-1776
    CrossrefPubMedGoogle Scholar
  • 49 Shi D, Qi J, Li D. et al. Fingertip Replantation at or beyond the Nail Base in Children. Microsurgery 2010; 30 (05) 380-385
    PubMedGoogle Scholar