Download PDF
J Hand Microsurg 2023; 15(05): 328-339
DOI: 10.1055/s-0043-1777066
Review Article

Review of Replantation Services from a Level One Trauma Center in India

Suvashis Dash
1   Department of Plastic, Reconstructive, and Burns Surgery, All India Institute of Medical Sciences, New Delhi, India
,
Raja Tiwari
1   Department of Plastic, Reconstructive, and Burns Surgery, All India Institute of Medical Sciences, New Delhi, India
,
Rakesh Dawar
1   Department of Plastic, Reconstructive, and Burns Surgery, All India Institute of Medical Sciences, New Delhi, India
,
Shivangi Saha
1   Department of Plastic, Reconstructive, and Burns Surgery, All India Institute of Medical Sciences, New Delhi, India
,
Maneesh Singhal
1   Department of Plastic, Reconstructive, and Burns Surgery, All India Institute of Medical Sciences, New Delhi, India
› Author Affiliations
› Further Information
    Permissions and Reprints

Abstract

The aim of this article is to examine the elements that contribute to effective operation of a specialized replantation center and to provide readers with a general idea of the outcome of replantation services in India. A dedicated high-volume center coupled with a sound referral system is the backbone of replantation services in a country. A retrospective study was done on all patients who visited a level 1 trauma center in India from November 1, 2017, to December 31, 2018, for various amputations. The medical records and digital pictures of these patients were extracted from the records and analyzed. During the study period, 77 replants were performed on 63 patients at our center. Males were 68% of the study, mostly belonging to the 20 to 40 years age group (63%). Thirty-four percent of cases were smokers. Agricultural injuries (49%) were the most common cause of amputation. Finger replantation was the most common type of replantation (82%). The rate of successful replantation was highest for scalp (100%) followed by hand (71%) and thumb (67%). Setting up dedicated replantation services is essential, especially in highly populated areas. Manpower, resources, and a protocol-led approach help in achieving optimum results. A multidisciplinary team approach with round-the-clock availability plays a vital role in intraoperative decision-making and planning postoperative rehabilitation.

Keywords

finger replantation - scalp replantation - hand replantation - limb replantation - replantation registry


Publication History

Article published online:
29 November 2023

© 2023. Society of Indian Hand Surgery & Microsurgeons. All rights reserved.

Thieme Medical and Scientific Publishers Pvt. Ltd.
A-12, 2nd Floor, Sector 2, Noida-201301 UP, India

 

  • References

  • 1 Werman HA, Zielinski A, Raetzke BD, Nappi JF. Limb replantation in air-transported patients: a 4-year study. Air Med J 2016; 35 (04) 239-241
    CrossrefPubMedGoogle Scholar
  • 2 Sabapathy SR, Venkatramani H, Bharathi RR, Bhardwaj P. Replantation surgery. J Hand Surg Am 2011; 36 (06) 1104-1110
    CrossrefPubMedGoogle Scholar
  • 3 Raja Sabapathy S. Management of complex tissue injuries and replantation across the world. Injury 2006; 37 (11) 1057-1060
    CrossrefPubMedGoogle Scholar
  • 4 Saito T, Nezu S, Matsuhashi M. et al. The trend of treatment and conveyance system for upper extremity replantation in Japan: a nationwide population-based study from the Japan trauma data bank. J Orthop Sci 2021; 26 (02) 271-275
    CrossrefPubMedGoogle Scholar
  • 5 Ono S, Chung KC. Efficiency in digital and hand replantation. Clin Plast Surg 2019; 46 (03) 359-370
    CrossrefPubMedGoogle Scholar
  • 6 Beris AE, Lykissas MG, Korompilias AV, Mitsionis GI, Vekris MD, Kostas-Agnantis IP. Digit and hand replantation. Arch Orthop Trauma Surg 2010; 130 (09) 1141-1147
    CrossrefPubMedGoogle Scholar
  • 7 Kashyap N, Singhal M, Tiwari R, Chauhan S, Manas R. Scalp avulsion injuries and replantation: is deep temporal artery an alternate option?. Ann Plast Surg 2020; 84 (02) 178-182
    CrossrefPubMedGoogle Scholar
  • 8 Nasir S, Karaaltin M, Erdem A. Total scalp replantation: surgical tricks and pitfalls. J Craniofac Surg 2015; 26 (04) 1192-1195
    CrossrefPubMedGoogle Scholar
  • 9 Iorio ML. Hand, wrist, forearm, and arm replantation. Hand Clin 2019; 35 (02) 143-154
    CrossrefPubMedGoogle Scholar
  • 10 Mahajan RK, Mittal S. Functional outcome of patients undergoing replantation of hand at wrist level-7 year experience. Indian J Plast Surg 2013; 46 (03) 555-560
    Article in Thieme ConnectPubMedGoogle Scholar
  • 11 Cavadas PC, Rubí C, Thione A, Pérez-Espadero A. Immediate versus overnight-delayed digital replantation: comparative retrospective cohort study of survival outcomes. J Hand Surg Am 2018; 43 (07) 625-630
    CrossrefPubMedGoogle Scholar
  • 12 Tos P, Crosio A, Giacalone F, Battiston B. Major Amputations at the Arm and Forearm Level: Replantation Strategy and Technique. In: Clinical Scenarios in Reconstructive Microsurgery: Strategy and Operative Techniques. Springer, Cham; 2020 DOI: 10.1007/978-3-319-94191-2_54-1
    CrossrefPubMedGoogle Scholar
  • 13 Tang JB, Wang ZT, Chen J, Wong J. A global view of digital replantation and revascularization. Clin Plast Surg 2017; 44 (02) 189-209
    CrossrefPubMedGoogle Scholar
  • 14 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
  • 15 Dubert T, Battiston B, Baeten Y, Böttcher R, Rosberg HE, Vögelin E. Hand Trauma Committee of FESSH. A new committee dedicated to understanding and helping hand trauma management in Europe: The FESSH Hand Trauma Committee. J Hand Surg Eur Vol 2010; 35 (04) 330-333
    CrossrefPubMedGoogle Scholar
  • 16 Haas EM, Volkmer E, Holzbach T, Wallmichrath J, Engelhardt TO, Giunta RE. Über Versorgungsstrukturen und Möglichkeiten der Optimierung durch Vernetzung bei schweren Handverletzungen und Replantationen. [Optimising care structures for severe hand trauma and replantation and chances of launching a national network] Handchir Mikrochir Plast Chir 2013; 45 (06) 318-322
    Article in Thieme ConnectPubMedGoogle Scholar
  • 17 American College of Surgeons. Committee on Trauma, American college of Surgeons. Resources for optimal care of the injured patient: 1993 . Amer College of Surgeons; 1993. Accessed August 3, 2023 at: https://www.facs.org/quality-programs/trauma/tqp/center-programs/vrc/resources
    PubMedGoogle Scholar
  • 18 Nerli RB, Ghagane SC. Trauma center is the need of the hour. Indian J Health Sci Biomed Res 2019; 12: 1-2
    CrossrefPubMedGoogle Scholar
  • 19 Rotondo MF, Cribari C, Smith SR. Eds. Resources for optimal care of the injured patient, ACS, Chicago (I.L.);. 2014 Accessed August 3, 2023 at: https://www.facs.org/~/media/files/quality%20programs/trauma/vrc%20resources/resources%20for%20optimal%20care.ashx
    PubMedGoogle Scholar
  • 20 Maroukis BL, Chung KC, MacEachern M, Mahmoudi E. Hand trauma care in the United States: a literature review. Plast Reconstr Surg 2016; 137 (01) 100e-111e
    CrossrefPubMedGoogle Scholar
  • 21 Chung KC, Kowalski CP, Walters MR. Finger replantation in the United States: rates and resource use from the 1996 healthcare cost and utilization project. J Hand Surg Am 2000; 25 (06) 1038-1042
    CrossrefPubMedGoogle Scholar
  • 22 Hustedt JW, Bohl DD, Champagne L. The detrimental effect of decentralization in digital replantation in the United States: 15 years of evidence from the national inpatient sample. J Hand Surg Am 2016; 41 (05) 593-601
    CrossrefPubMedGoogle Scholar
  • 23 Friedrich JB, Poppler LH, Mack CD, Rivara FP, Levin LS, Klein MB. Epidemiology of upper extremity replantation surgery in the United States. J Hand Surg Am 2011; 36 (11) 1835-1840
    CrossrefPubMedGoogle Scholar
  • 24 Breahna A, Siddiqui A, Fitzgerald O'Connor E, Iwuagwu FC. Replantation of digits: a review of predictive factors for survival. J Hand Surg Eur Vol 2016; 41 (07) 753-757
    CrossrefPubMedGoogle Scholar
  • 25 Neinstein RM, Dvali LT, Le S, Anastakis DJ. Complete digital amputations undergoing replantation surgery: a 10-year retrospective study. Hand (N Y) 2012; 7 (03) 263-266
    CrossrefPubMedGoogle Scholar
  • 26 Brown M, Lu Y, Chung KC, Mahmoudi E. Annual hospital volume and success of digital replantation. Plast Reconstr Surg 2017; 139 (03) 672-680
    CrossrefPubMedGoogle Scholar
  • 27 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
  • 28 Dec W. A meta-analysis of success rates for digit replantation. Tech Hand Up Extrem Surg 2006; 10 (03) 124-129
    CrossrefPubMedGoogle Scholar
  • 29 Nishijima A, Yamamoto N, Yanagibayashi S. et al. The effect of smoking on necrosis rate in digital replantation and revascularization with prostaglandin E1 therapy: a retrospective study. Plast Reconstr Surg 2016; 138 (04) 848-853
    CrossrefPubMedGoogle Scholar
  • 30 He JY, Chen SH, Tsai TM. The risk factors for failure of an upper extremity replantation: is the use of cigarettes/tobacco a significant factor?. PLoS One 2015; 10 (10) e0141451
    CrossrefPubMedGoogle Scholar
  • 31 Dixon AJ, Dixon MP, Dixon JB, Del Mar CB. Prospective study of skin surgery in smokers vs. nonsmokers. Br J Dermatol 2009; 160 (02) 365-367 [PubMed] [Google Scholar]
    CrossrefPubMedGoogle Scholar
  • 32 Tantry TP, Kadam D, Shenoy SP, Bhandary S, Adappa KK. Perioperative evaluation and outcomes of major limb replantations with ischemia periods of more than 6 hours. J Reconstr Microsurg 2013; 29 (03) 165-172
    Article in Thieme ConnectPubMedGoogle Scholar
  • 33 Sirimaharaj W, Boonpadhanapong T. Scalp replantation: a case report of long ischemic time. J Med Assoc Thai 2001; 84 (11) 1629-1634 . PMID: 11853308
    PubMedGoogle Scholar
  • 34 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
  • 35 Oruç M, Gürsoy K, Özer K. et al. Eight years of clinical experience with digit replantation: demographic characteristics and outcomes. Ulus Travma Acil Cerrahi Derg 2017; 23 (04) 311-316
    PubMedGoogle Scholar
  • 36 Harbour PW, Malphrus E, Zimmerman RM, Giladi AM. Delayed digit replantation: what is the evidence?. J Hand Surg Am 2021; 46 (10) 908-916
    CrossrefPubMedGoogle Scholar
  • 37 Nishijima A, Yamamoto N, Gosho M. et al. Appropriate use of intravenous unfractionated heparin after digital replantation: a randomized controlled trial involving three groups. Plast Reconstr Surg 2019; 143 (06) 1224e-1232e
    CrossrefPubMedGoogle Scholar
  • 38 Efanov JI, Khriguian J, Cassier S. et al. Duration and cessation characteristics of heparinization after finger replantation: a retrospective analysis of outcomes. Microsurgery 2018; 38 (03) 251-258
    CrossrefPubMedGoogle Scholar
  • 39 Sears ED, Chung KC. Replantation of finger avulsion injuries: a systematic review of survival and functional outcomes. J Hand Surg Am 2011; 36 (04) 686-694
    CrossrefPubMedGoogle Scholar
  • 40 Cho HE, Zhong L, Kotsis SV, Chung KC. Finger replantation optimization study (FRONT): update on national trends. J Hand Surg Am 2018; 43 (10) 903-912.e1
    CrossrefPubMedGoogle Scholar
  • 41 Selber JC, Chang EI, Liu J. et al. Tracking the learning curve in microsurgical skill acquisition. Plast Reconstr Surg 2012; 130 (04) 550e-557e
    CrossrefPubMedGoogle Scholar