2012, Number 3
Cir Plast 2012; 22 (3)
Comparison between the various mechanisms of amputation and the incidence of digital necrosis in reimplantation
de la Parra MML, Naal MN
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Accidents at work are the leading cause of finger amputation. Unfortunately, not all patients are candidates for digital reimplantation. In the following study we have reimplanted all the amputated fingers, regardless of the mechanism and level of amputation. We performed a prospective cohort study with two groups with 11 reimplanted fingers each. The first group with clean amputation and the second with severely fingers mangled. By a Fisher exact test we compared the incidence of digital necrosis between the groups. 73% of the patients were men. The index and middle fingers of the right hand were the most affected. The proximal phalanx was the most common level (Area IV). The success of the reimplanted fingers with clean amputation (Group 1) was 82% and the group with fingers with severe pounding amputation (Group 2) was 36.4% (p = 0.04). The mechanisms of twisting and wrenching showed the worst prognosis. The level of amputation had no significant influence in our study. We concluded that the fingers with clean amputation have a better prognosis after reimplantation; however, the fingers that were severe crushed still have a 36.4% chance of success, therefore, we recommend trying reimplantation in these patients.
Lombardi DA, Sorock GS, Hauser R, Nasca P, Elsen E, Herrick RF et al. Temporal factors and the prevalence of transient exposures at the time of an occupational traumatic hand injuries. J Occup Environ Med 2003; 45(8): 832-840.
Goldner RD, Fitch RD, Nunley JA et al. Demographics and replantation. J Hand Surg 1987; (5 Pt 2): 961-965.
Baker GL, Kleinert JM. Digit replantation in infants and young children: determinants of survival. Plast Reconstr Surg 1994; 94: 139-145.
Jacobson J, Suarez E. Microsurgery in anastomosis of small vessels. Surg Forum 1960; 11: 243-245.
Komatsu S, Tamai S. Successful replantation of a completely cut-off thumb. Plast Reconstr Surg 1968; 42(4): 374-377.
Tamai S. Digit replantation. Analysis of 163 replantation in an 11 year period. Clin Plast Surg 1998; 51: 195-209.
Alcivar E et al. Reimplante de miembro superior. Indicaciones, técnicas y resultados. Rev Soc Ecuat Traum y Ortop 1984; 1(2): 151-156.
Malt R, McKhann C. Replantation of severed arms. J Am Med Assn 1962; 189: 716-722.
Hashmi PM. Digital re-implantation: Akuh experience. J Bone Joint Surg 2002; 84-B(Suppl. III): 241-242.
Adams WP Jr, Ansari MS, Hay MT et al. Patency of different arterial and venous end-to-side microvascular techniques in rat model. Plast Reconstr Surg 2000; 105: 156.
Conrad MH, Adams WP Jr. Pharmacologic optimization of microsurgery in the new millennium. Plast Reconstr Surg 2001; 108(7): 2088-2096.
Helstein JB, Cook PA. Factors affecting composite graft survival in digital tip amputations. Ann Plast Surg 2003; 50(3): 299-303.
Chiu HY, Shieh SJ, Hsu HY. Multivariate analysis of factors influencing the functional recovery after finger replantation or revascularization. Microsurgery 1995; 16: 713-717.
Tamai S. Twenty years’ experience of limb replantation-review of 293 upper extremity replants. J Hand Surg Am 1982; 7: 549-556.
Tamai S, Hori Y, Tatsumi Y, Okuda H, Nakamura Y et al. Microvascular anastomosis and its application on the replantation of amputated digits and hands. Clin Orthop Relat Res 1978; 133: 106-121.
Ishikawa K, Ogawa Y, Soeda H, Yoshida Y. A new classification of the amputated level for the distal part of the finger. J Jpn Soc Reconstr Microsurg 1990; 3: 54-62.
Michalko KB, Bentz ML. Digital replantation in children. Crit Care Med 2002; 30: 444-447.
Millesi H et al. Eafahrungen mit der microchirugie peripherer nerven. Cir Plast Reconstr 1967; 3: 47-52.
Akyürek M, Safak T, Keçik A. Ring avulsion replantation by extended debridement of the avulsed digital artery and interposition with long venous grafts. Ann Plast Surg 2002; 48: 574-581.
Hallock GG. Venae comitantes as a source of vein grafts. J Reconstr Microsurg 2007; 23(4): 219-223.
Ritter EF, Fata MM, Rudner AM, Klitzman B. Heparin bonding increases patency of long microvascular prostheses. Plast Reconstr Surg 1998; 101(1): 142-146.
Akyürek M, Safak T, Keçik A. Fingertip replantation at or distal to the nail base: use of technique of artery-only anastomosis. Ann Plast Surg 2001; 46: 605-612.
Schlenker JD, Kleinert HE, Tsai TM. Methods and results of replantation following traumatic amputation of the thumb in sixty four patients. J Hand Surg Am 1980; 5(1): 63-70.
Ward WA, Tsai TM, Breidenbach W. Per-primam thumb replantation for all patients with traumatic amputations. Clin Orthop Relat Res 1991; 266: 90-95.
Sharma S, Lin S, Panozzo A, Tepper R, Friedman D. Thumb replantation: a retrospective review of 103 cases. Ann Plast Surg 2005; 55: 352-356.
Jablecki J et al. Digital replantation in the 5th zone according to the Tamai classification. Pol Przegl Chir 1996; 68: 166-174.
Makoto M, Nakanishi M, Nakashima M, Narishima M, Gonda K, Koshima I. Distal phalanx replantation using the delayed venous method: a high success rate in 21 cases without specialized technique. J Plast Reconstr Aest Surg 2008; 61: 88-93.
Ozcelik IB, Purisa H, Sezer I, Mersa B, Aydin A. The result of digital replantations at the level of distal interphalangeal joint and the distal phalanx. Acta Orthop Traumatol Turc 2006; 40(1): 62-66.
Yamano Y. Results of fingertip replantation according to amputation types. J Bone Joint Surg Br 2003; 85(Suppl. 1): 25-26.
Iglesias M, Serrano A. Replantation of amputated segments after prolonged ischemia. Plast Reconstr Surg 1990; 85: 425-429.
Wei FC, Chang YL. Three successful digital replantations in a patient after 84, 86 and 94 hours of cold ischemia time. Plast Reconstr Surg 1988; 82: 346-350.
Quing-Tai L, Chang-Quing Z, Ke-Fei Y, Sha-Ling C, Jan L, Zun-Ying L. Successful replantation in 10-digit complete amputations. Plast Reconstr Surg 1996; 98(2): 348-353.
Tian Fang-Chen et al. A successful case of replantation of 10 completely amputated fingers: report of one case. In Proceedings of the Third All-China conference of hand surgery. 1988; 53-55.
Chai Lin-Fang et al. Successful replantation of 10 amputated fingers: a case report. in proceedings of the Fourth-All China conference of hand surgery. 1990; 25-26.
Sharma S, Lin S, Panozzo A, Tepper R, Friedman D. Thumb replantation: a retrospective review of 103 cases. Ann Plast Surg 2005; 55(4): 352-356.
Koul AR, Cyriac A, Khaleel VM, Vinodan K. Bilateral high upper limb replantation in a child. Plast Reconstr Surg 2004; 113: 1734-1738.
Schmidhammer R, Nimmervoll R, Penlinka LE, Huber W, Schrei K et al. Bilateral lower leg replantation versus prosthetic replacement: long-term outcome of amputation after an occupational railroad accident. J Trauma 2004; 57: 824-831.
Naffzinger R. Technique for optimizing exposure in great toe revascularization and replantation. Plast Reconstr Surg 2003; 112: 704-706.
Lewis EC, Fowler JR. Two replantations of severed ear parts. Plast Reconstr Surg 1979; 64: 703-705.
Tajima S, Ueda K, Tanaka Y. Successful replantation of a bitten-off nose by microvascular anastomosis. Microsurgery 1989; 10: 5-7.
James NJ. Survival of large replanted segment of upper lip and nose. Case report. Plast Reconstr Surg 1976; 58: 623-625.
Chen S, Shu WM, Wei FC, Tsai YC. Eyebrow revascularization. Ann Plast Surg 1991; 26: 174-177.
Buncke HJ, Rose EH, Brownstein MJ, Chater NL. Successful replantation of two avulsed scalps by microvascular anastomoses. Plast Reconstr Surg 1978; 61: 666-672.
Thomas A. Six years after face replantation. J Reconstr Microsurg 2002; 18: 250.
Charles D, Armstrong J. Replantation of an amputated tongue. Plast Reconstr Surg 2001; 108: 1441-1442.
Wei FC, McKee NH, Huerta FJ, Robinette MA. Microsurgical replantation of a completely amputated penis. Ann Plast Surg 1983; 10: 317-321.
De la Parra MM, Mondragón GS, López PJ, Naal MN, Rangel FJ. Reimplante facial utilizando la arteria labial para revascularización: reporte de un caso. Cir Ciruj 2013; 81(2), (En prensa).