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14th Triennial Congress of the International Federation of Societies for Surgery of the Hand (IFSSH), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT)

17.06. - 21.06.2019, Berlin

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Survival rates and outcomes for digital replantation

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  • Mohsen Rafii - University of Buckingham, Buckingham, United Kingdom
  • presenting/speaker Christopher Deutsch - Royal Free Hospital, London, United Kingdom

International Federation of Societies for Surgery of the Hand. International Federation of Societies for Hand Therapy. 14th Triennial Congress of the International Federation of Societies for Surgery of the Hand (IFSSH), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT). Berlin, 17.-21.06.2019. Düsseldorf: German Medical Science GMS Publishing House; 2020. DocIFSSH19-1924

doi: 10.3205/19ifssh0259, urn:nbn:de:0183-19ifssh02590

Published: February 6, 2020

© 2020 Rafii et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.

Outline

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Objectives/Interrogation: Since the development of microsurgical vascular anastomoses, digital replantation has become a well-established procedure in the field of reconstructive hand surgery. Advancements in surgical techniques and peri-operative management of such patients has resulted in high survival rates globally, with increasing focus now falling on achieving optimal functional outcome. This review will assess the literature on the outcomes of digital replant surgery, exploring the evidence pertinent to survival rates and functional outcomes.

Methods: A systematic search of the MEDLINE database was performed using predefined criteria. 21 review papers met the criteria reporting on outcomes of 1142 patients. The literature was reviewed examining variables concerning the injury, the patient, and surgical management assessing the impact on replant survival and functionality. Assessment of functional outcomes evaluated; active range of movement, two point discrimination, grip strength and return to work.

Results and Conclusions: Findings demonstrated various factors influencing replant survival, including; mechanism and site of amputation, type and duration of ischaemic insult, surgical techniques, and postoperative care and rehabilitation. Factors shown to be most influential in replant survival were; patient's age, mechanism of injury and number of anastomoses. Patients >50 and those <5 years of age demonstrated the highest failure rates, while the optimum patient group was 11-20 years of age. Guillotine injuries exhibited the best survival outcomes overall, when compared to crush/avulsion injuries. Enhanced survival outcomes were demonstrated in Zone 2 relative to Zone 1 (Tamai classification) in distal injuries, and proximal to the MCP in proximal injuries. In the analysis of functional outcomes literature revealed optimum functional restoration in injuries distal to the insertion of flexor digitorum superficialis, however in cases of injury sustained to the tendon, early secondary flexor tendon reconstruction and digital motion should be considered.