Artikel
Replantations in Norway 2010–2017
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Autoren
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Johanne Korslund
- Oslo University Hospital, Oslo, Norway
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Ole Reigstad
- Oslo University Hospital, Oslo, Norway
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Rasmus Thorkildsen
- Oslo University Hospital, Oslo, Norway
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Magne Røkkum
- Oslo University Hospital, University of Oslo, Oslo, Norway
| Veröffentlicht: | 6. Februar 2020 |
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Gliederung
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Objectives/Interrogation: The first replantation in Norway was performed in 1983. Since 1994 all replantations in Norway have been performed at one hospital. The number of replantations per year steadily increased, stabilizing between 50 and 70 per year for the last two decades, except for a 3 year period. We assessed the replantations performed in Norway between 2010 and 2017.
Methods: From 01.01.2010-31.12.2017 380 patients, 48 (2-92) years of age underwent replantation surgery. Of these there were 45 (12%) women and 32 (8%) children <18 years. 34 patients (9%) had proximal upper extremity amputations (13 wrists, 21 lower arms). 3 patients had toes/feet replanted, and one patient had his penis replanted. The remaining 342 patients had 512 fingers replanted, including 135 thumbs. The dominant side was amputated in 42% of the injuries. 82% of the injuries were classified as crushing injuries, 15% avulsion, and only 3% guillotine.
Results and Conclusions: 32/34 (94%) of the proximal upper extremity replantations survived. 338/512 fingers (66%), and 88/135 thumbs (65%) survived. Due to secondary circulatory failure 146/512 (28%) fingers underwent repeated microvascular surgery to restore circulation. This secondary surgery saved 58/146 (40%) fingers. During the follow up period, 56% of the replanted fingers needed further surgery after primary replantation, including secondary recirculation surgery, smaller wound revisions, coverage procedures, scar correction, tenolysis or pseuarthrosis surgery. 3/338 (1%) were amputated at a later stage because of pain, stiffness and bad function. The patients came from all over Norway, proportionately to population distribution in the different regions of the country.
Replantation is a demanding procedure for the patient with a long period of hospitalization and rehabilitation. Approximately half of the patients need more than one surgery. The surgery is technically demanding, time consuming and requires considerable resources both during the initial hospitalization and during follow up. Centralization to one centre has allowed us to gain, and maintain surgical experience despite a small population (5 million). The results are not quite as good as those cited from other centres, but the high percentage of crushing injuries may in part explain this.
