Flying Solo: A Single Year-Single Surgeon Community Hospital Replantation/ Revascularization Experience

ABSTRACT

A recent 12-month review of the emergent replantation/revascularization experience of a solo practice microsurgeon in a community hospital environment is presented. A total of 67 digits and/or hands/limbs were operated on in 51 patients with a success rate of 87 percent. There were nine failures, all in digits with crush-avulsion etiologies. These results support the position that the single microsurgeon practicing in a community hospital environment can provide levels of care for patients with amputated or devascularized digits and parts comparable to tertiary medical centers.

KEYWORDS

Replantation - revascularization - community hospital

REFERENCES

• 1 Bieber E. Thumb avulsion: results of replantation and revascularization.  J Hand Surgery . 1987;  12 786-789
• 2 Wilson C, Alpert B, Buncke H, Gordon L. Replantation of the upper extremity.  Clin Plast Surg . 1983;  10 85-101
• 3 Malt R, McKhann C. Replantation of severed arms.  JAMA . 1964;  198 716
• 4 Komaysu S, Tamai S. Successful replantation of a completely cut-off thumb.  Plast Reconstr Surg . 1968;  42 374-377
• 5 May J, Toth B, Gardner M. Digital replantation distal to the proximal interphalangeal joint.  J Hand Surg . 1982;  7A 161-166
• 6 Kleinert H, Jablon M, Tsai T. An overview of replantation and results of 347 replants in 245 patients.  J Trauma . 1980;  20 390-397
• 7 Merle M, Dautel G. Advances in digital replantation.  Clin Plast Surg . 1997;  24 87-105
• 8 Furnas D. Microsurgery and the community-based plastic surgeon.  Clin Plast Surg . 1983;  10 145-148
• 9 Merle M, Dautel G. La Main Traumatique, L'Urgence. Paris Masson; 1992
• 10 Merle M, Dap F, Bour C. Digital replantation. In: Meyer V, Black M, eds. Microsurgical Procedures, Hand and Upper Limb, vol. 8 Edinburgh: Churchill, Livingstone 1991
• 11 Fukui A, Inada Y, Tamai S. Two methods for obtaining satisfactory results in digital replantation. Presented at the 26th Annual Meeting of the Japanese Society of Microsurgery, Tokyo, Japan, November, 1999
• 12 Furnas D, Salibian A, Achauer B. Genesis of a replantation program.  Am J Surg . 1978;  136 21
• 13 Arai K, Toh S, Yasumara M, Tsubo K. Outcomes of replantation for single amputated digits. Presented at the 26th Annual Meeting of the Japanese Society of Microsurgery, Tokyo, Japan, November, 1999
• 14 McAuliffe J. The upper extremity trauma patient.  Hand Clin . 1999;  15 187-191
• 15 Goldner R, Howson M, Belding N. One hundred thumb amputations: replantation versus revision.  Microsurgery . 1990;  11 245-250
• 16 Foucher G, Norris R. Distal and very distal digital replantations.  Br J Plast Surg . 1992;  45 199
• 17 Libermanis O, Krauklis G, Kapickis M. Distally-based forearm flow-through flaps for emergency finger revascularization.  J Reconstr Microsurg . 2001;  17 607-610
• 18 Brandt K, Khouri R, Upton J. Free flaps as flow-through vascular conduits for simultaneous coverage and revascularization of the hand and digits.  Plast Reconstr Surg . 1996;  98 321-327
• 19 Smith A, Bowen C, Rabczak T, Boyd J. Donor site deficit of the osteo-cutaneous radial forearm flap.  Ann Plast Surg . 1994;  32 372-376
• 20 Goldberg J, Buncke H, Buncke G. Replantation of amputated parts. In: Georgiade G, Riefkohl D, Levin S, eds. Plastic, Maxillofacial and Reconstructive Surgery, 3rd edition Philadelphia: Williams & Wilkins 1997