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Shuiqi Cai - One of the best experts on this subject based on the ideXlab platform.
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effects of ozone autohemotherapy on blood vegf tgf β and pdgf levels after Finger Replantation
Annals of palliative medicine, 2020Co-Authors: Weiting Chen, Jingzhao Xia, Zhongbin Lai, Ji Yao, Shuiqi CaiAbstract:BACKGROUND The study aimed to confirm the important role of ozone autologous blood therapy (autohemotherapy) in promoting successful Finger Replantation and its possible influence mechanism. METHODS A total of 150 patients with severed Finger Replantation admitted to our hospital from March 2018 to March 2019 were selected. Patients were divided into observation group and control group according to different treatment methods. The observation group received additional ozone autologous blood treatment in the control group. We compared the number of white blood cells, visual analogue scale (VAS) scores, and the expression levels of vascular endothelial growth factor (VEGF), transforming growth factor-β (TGF-β), and platelet-derived growth factor (PDGF) in the two groups of patients before and after intervention. We also assessed the hospitalization time and survival time of the replanted Finger in the two groups, as well as blood flow values (Vbcf). RESULTS Compared with the observation group on the 1st day after the operation and the control group on the 7th day after the operation, the average white blood cell count of the observation group on the 7th day after the operation was significantly increased (P<0.05), and the VAS score was significantly decreased (P<0.05).48 hours after the operation, the average Vbcf value of the replanted Finger was lower than that of the contralateral healthy Finger (P<0.05). Compared with the control group, the Vbcf value of the replanted Fingers in the observation group was higher, and the hospitalization time and Finger survival time were shorter (P<0.05). At 7 days after operation, the serum VEGF, TGF-β and PDGF levels in the observation group were significantly higher than the 1 day after operation, before the operation and the control group (P<0.05). CONCLUSIONS Intervention with ozone autohemotherapy after severed Finger Replantation can significantly increase the number of white blood cells, relieve postoperative pain, and improve the survival rate of the Finger body. Ozone autohemotherapy also improves the microcirculation after anastomosis of the severed Finger by up-regulating the expression of VEGF, TGF-β and PDGF in blood.
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Effects of ozone autohemotherapy on blood VEGF, TGF-β and PDGF levels after Finger Replantation.
Annals of palliative medicine, 2020Co-Authors: Weiting Chen, Jingzhao Xia, Zhongbin Lai, Ji Yao, Shuiqi CaiAbstract:BACKGROUND The study aimed to confirm the important role of ozone autologous blood therapy (autohemotherapy) in promoting successful Finger Replantation and its possible influence mechanism. METHODS A total of 150 patients with severed Finger Replantation admitted to our hospital from March 2018 to March 2019 were selected. Patients were divided into observation group and control group according to different treatment methods. The observation group received additional ozone autologous blood treatment in the control group. We compared the number of white blood cells, visual analogue scale (VAS) scores, and the expression levels of vascular endothelial growth factor (VEGF), transforming growth factor-β (TGF-β), and platelet-derived growth factor (PDGF) in the two groups of patients before and after intervention. We also assessed the hospitalization time and survival time of the replanted Finger in the two groups, as well as blood flow values (Vbcf). RESULTS Compared with the observation group on the 1st day after the operation and the control group on the 7th day after the operation, the average white blood cell count of the observation group on the 7th day after the operation was significantly increased (P
Kevin C. Chung - One of the best experts on this subject based on the ideXlab platform.
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Cost-effectiveness of Finger Replantation Compared With Revision Amputation
JAMA network open, 2019Co-Authors: Alfred P. Yoon, Kevin C. Chung, Tanvi Mahajani, David W. Hutton, Satisfaction Amputation Challenges In Assessing ImpairmentAbstract:Importance Traumatic digit amputation is the most common type of amputation injury, but the cost-effectiveness of its treatments is unknown. Objective To assess the cost-effectiveness of Finger Replantation compared with revision amputation. Design, Setting, and Participants This economic evaluation was conducted using data from the Finger Replantation and Amputation Challenges in Assessing Impairment, Satisfaction, and Effectiveness (FRANCHISE), a retrospective, multicenter cohort study at 19 centers in the United States and Asia that enrolled participants from August 1, 2016, to April 12, 2018. Model variables were based on the FRANCHISE database, Centers for Medicare & Medicaid Services, and published literature. A total of 257 participants with unilateral traumatic Finger amputations treated with revision amputation or Replantation distal to the metacarpophalangeal joint and at least 1 year of follow-up after treatment were included in the analysis. Exposures Revision amputation or Replantation of traumatic Finger amputations. Main Outcomes and Measures Main outcome measures were quality-adjusted life-years (QALYs), total costs (in US dollars), and incremental cost-effectiveness ratios (ICERs). A willingness-to-pay threshold of $100 000 per QALY was used to assess cost-effectiveness. Results Of the 257 study participants (mean [SD] age, 46.7 [15.9] years; 221 [86.0%] male), 178 underwent Finger Replantation and 79 underwent revision amputation. In a base case of a 46.7-year-old patient, Replantation was associated with QALY gains of 0.30 (95% credible interval [CrI], −0.72 to 1.38) for single-Finger (not thumb), 0.39 (95% CrI, −1.00 to 1.90) for thumb, 1.69 (95% CrI, −0.13 to 3.76) for multiFinger excluding thumb, and 1.27 (95% CrI, −2.21 to 5.04) for multiFinger including thumb injury patterns. Corresponding ICERs for Replantation compared with revision amputation were $99 157 per QALY for single-Finger (not thumb), $66 278 per QALY for thumb, $18 388 per QALY for multiFinger excluding thumb, and $21 528 per QALY for multiFinger including thumb injury patterns. Sensitivity analysis revealed that age at time of injury, life expectancy, postinjury utility, wages, and time off work for recovery had the strongest associations with cost-effectiveness. Probabilistic sensitivity analysis revealed the following chances of Replantation being cost-effective: 47% in single-Finger (not thumb), 52% in thumb, 78% in multiFinger excluding thumb, and 64% in multiFinger including thumb injury patterns. Conclusions and Relevance With proper patient selection, Replantation of all Finger amputation patterns, whether single-Finger or multiFinger injuries, may be cost-effective compared with revision amputation. MultiFinger Replantations had a higher probability of being cost-effective than single-Finger Replantations. Cost-effectiveness may depend on injury pattern and patient factors and thus appears to be important for consideration when patients and surgeons are deciding whether to replant or amputate.
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Finger Replantation optimization study front update on national trends
Journal of Hand Surgery (European Volume), 2018Co-Authors: Hoyune E Cho, Lin Zhong, Sandra V Kotsis, Kevin C. ChungAbstract:Purpose Traumatic digit amputations have an adverse impact on patients’ daily living. Despite experts advocating for digit Replantation, studies have shown a continued decrease in rate of Replantation. We performed a national-level investigation to examine the recent trend of practice for digital Replantation. Methods We used the National Inpatient Sample database under the Healthcare Cost and Utilization Project to select adult patients with traumatic digit amputation from 2001 to 2014. We calculated the rate of attempted and rate of successful digit Replantation per year, subcategorizing for digit type (thumb or Finger) and for hospital type (rural, urban nonteaching, or urban teaching). We also analyzed the pattern of distribution of case volume to each hospital type per year. We used 2 multivariable logistic regression models to investigate patient demographic and hospital characteristics associated with the odds of Replantation attempt and success. Results Among the 14,872 adult patients with a single digit amputation from 2001 to 2014, only 1,670 (11.2%) underwent Replantation. The rate of Replantation attempt trended down over the years for both thumb and Finger injuries at all hospital types, despite increasing proportions of cases being sent to urban teaching hospitals where they were more than twice as likely to undergo Replantation. The rate of successful Replantation stayed stable for the thumb at 82.9% and increased for Fingers from 76.1% to 82.4% over the years. Patients were more likely to undergo Replantation if they had private insurance or a higher level of income. Neither hospital case volume nor hospital type was predictive of successful Replantation. Conclusions Although more single-digit amputations were treated by urban teaching hospitals with higher likelihood to replant, the downward trend in rate of attempt regardless of hospital type demonstrates that concentration of case volume is not the solution to reverse the declining trend. Clinical relevance Financial aspects of digit Replantation need to be considered from both the patients’ and the surgeons’ perspectives to improve delivery of care for digit Replantation.
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Annual Hospital Volume and Success of Digital Replantation.
Plastic and reconstructive surgery, 2017Co-Authors: Matthew Brown, Kevin C. Chung, Elham MahmoudiAbstract:Background Digital Replantation attempt and success rates have been declining in the United States. Regionalization of digit Replantation has been proposed as a solution to improve both attempt and success rates of these procedures. There is limited information about which criteria could establish a hospital as a center specialized for digit Replantation. The authors analyzed hospital Replantation volume and patient factors associated with successful thumb/Finger Replantation. Methods A retrospective study using data from the 2008 to 2012 State Inpatient Databases of the Health Care Cost and Utilization Project from five states (New York, California, North Carolina, Utah, and Florida) was performed. The generalized estimating equation method was used to examine the association between patient characteristics and hospital volume and success of thumb/Finger Replantation. A receiver operating characteristic curve and Youden's J statistic were used to determine annual hospital Replantation volume cutoff levels for success rates. Results There were 3417 digit amputation injuries, with 631 Replantation attempts (18 percent) and with an overall thumb/Finger Replantation success rate of 70 percent. The hospital annual Replantation volume increased the odds of success (OR, 1.06; 95 percent CI, 1.02 to 1.10). The annual hospital volume of three Replantations was needed to achieve a success rate of 70 percent. Conclusions Practice patterns demonstrate that hospitals with higher annual volume have greater success. Identifying high-volume centers and regionalization of digit Replantation should be considered a priority. Clinical question/level of evidence Therapeutic, III.
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Finger Replantation in the United States: rates and resource use from the 1996 Healthcare Cost and Utilization Project.
The Journal of hand surgery, 2000Co-Authors: Kevin C. Chung, Christine P. Kowalski, Madonna R. WaltersAbstract:Although Finger Replantation has been performed by hand surgeons in the United States for over 30 years the epidemiology of this procedure has not been studied. We used a national sampling database from the Agency for Health Care Policy and Research to summarize descriptive statistics surrounding Finger Replantation in the United States. This sample contained 304 cases of Finger Replantation performed in 1996. Mean hospital length of stay was 5.5 days and mean total charges were $20,330. Of the 906 hospitals included in this database, only 136 performed Finger Replantation during 1996. Of those, 60% performed only one case and 2% performed 10 or more cases. This descriptive analysis provides an examination of the largest sample size to date of Finger Replantation in the United States. Epidemiologic studies using national databases can provide researchers and policy makers with the analyses needed to examine treatment options and appropriately allocate future health care resources.
Zhenqing Liu - One of the best experts on this subject based on the ideXlab platform.
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the application of strengthened night nursing to the prevent of vascular crisis in patients after Finger Replantation
The Journal of practical nursing, 2017Co-Authors: Lingling Shi, Zhenqing LiuAbstract:Objective To investigate application effect of strengthened night nursing to the prevent of vascular crisis in patients after Finger Replantation. Methods A total of 155 patients with Finger Replantation in Hand surgery from February 2014 to February 2016 were selected as research object, 90 cases from March 2015 to February 2016 with strengthened night nursing were as the observation group, 65 cases from February 2014 to February 2015 with routine nursing were as the control group. The two groups were compared of limb Replantation success rate, vascular crisis rate and nursing satisfaction. Results The Replantation success rate in the observation group was 90.00%(81/90) higher than 76.92%(50/65) in the control group, the occurrence of vascular crisis rate was 11.11%(10/90) lower than 27.69%(18/65) in the control group, the success rate was 7/10 higher than 10/18 in the control group, and the difference was statistically significant (χ2=4.932, 7.013, 4.216, all P<0.05). The nursing satisfaction in the observation group was (94.32±3.57) points, 93.33%(84/90) higher than (91.22±4.48) points, 83.08%(54/65) in the control group, and the difference was statistically significant (t=4.789, χ2=4.071, P<0.05). Conclusions Strengthened night nursing can effectively prevent vascular crisis in patients after Finger Replantation, improve nursing satisfaction of patients. Key words: Strengthened; Night nursing; Replantation; Vascular crisis; Prevention
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The application of strengthened night nursing to the prevent of vascular crisis in patients after Finger Replantation
The Journal of practical nursing, 2017Co-Authors: Lingling Shi, Zhenqing LiuAbstract:Objective To investigate application effect of strengthened night nursing to the prevent of vascular crisis in patients after Finger Replantation. Methods A total of 155 patients with Finger Replantation in Hand surgery from February 2014 to February 2016 were selected as research object, 90 cases from March 2015 to February 2016 with strengthened night nursing were as the observation group, 65 cases from February 2014 to February 2015 with routine nursing were as the control group. The two groups were compared of limb Replantation success rate, vascular crisis rate and nursing satisfaction. Results The Replantation success rate in the observation group was 90.00%(81/90) higher than 76.92%(50/65) in the control group, the occurrence of vascular crisis rate was 11.11%(10/90) lower than 27.69%(18/65) in the control group, the success rate was 7/10 higher than 10/18 in the control group, and the difference was statistically significant (χ2=4.932, 7.013, 4.216, all P
Yusuf Gürbüz - One of the best experts on this subject based on the ideXlab platform.
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Clinical outcomes of salvage revision surgery following Finger Replantation with vascular insufficiency: A retrospective study
Acta orthopaedica et traumatologica turcica, 2020Co-Authors: Özgün Barış Güntürk, Murat Kayalar, Ulas Bali, Kemal Ozaksar, Tulgar Toros, Yusuf GürbüzAbstract:The aim of this study was to analyze the outcomes of revision surgery following Replantation of single digital amputations. In this study, first, a total of 403 patients (339 male, 64 female; mean age=28 years; age range=1-76) in whom a single Finger Replantation was performed were retrospectively reviewed, and then 60 patients with arterial or venous insufficiency in whom revision surgery was performed were reanalyzed. The second Finger was observed to be the most injured one (32.8%). Injury type was classified as clean cut (25.3%), local crush (38.7), extensive crush (7.9%), and avulsion (28.1%). When taking the levels of injuries of the artery-only Finger Replantations into account, one Finger (0.8%) was nail distal third, 70 Fingers (56%) were nail distal third to lunula, 43 Fingers (34.4%) were lunula to distal phalanx basis, 10 Fingers (8%) were distal interphalangeal (DIP) joint, and one Finger (0.8%) was middle phalanx. Operative revision was performed on 60 (14.9%) Fingers. The need for operative revision was arterial insufficiency in 37 Fingers (61.7%) and venous insufficiency in 23 Fingers (38.3%). The average revision time was 43 (range=6-144) hours. While the average elapsed time for artery procedures was 35.3 (range=8-110) hours, the average elapsed time for vein procedures was 47.1 (range=6-144) hours. Finger survival rates were examined. Injury mechanism, amputation level, the number of artery/vein repairs and methods were examined in all patients and revision patients separately. After the Replantations, according to survival analysis, while 342 (84.9%) Fingers were operated upon successfully, 61 (15.1%) Fingers developed necrosis. In the patients with revision surgery, the survival rate was 78.3%. The need for revision was arterial insufficiency in 37 Fingers (61.7%) and venous insufficiency in 23 Fingers (38.3%). The revision rate was significantly lower than other injury types in clean-cut cases. In terms of levels of injury, no revisions were required from distal to lunula level, and the highest revision rate was observed at the proximal interphalangeal (PIP) joint level. The results of the present study have shown that early re-exploration can provide a 78.3% success rate and can increase the survival rate from 67.6% to 84.2% following Replantation of single digital amputations. Surgical re-exploration seems to be a reasonable salvage for replanted Fingers with vascular insufficiency. Level IV, Therapeutic study.
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clinical outcomes of salvage revision surgery following Finger Replantation with vascular insufficiency a retrospective study
Acta Orthopaedica et Traumatologica Turcica, 2020Co-Authors: Özgün Barış Güntürk, Murat Kayalar, Ulas Bali, Kemal Ozaksar, Tulgar Toros, Yusuf GürbüzAbstract:OBJECTIVE The aim of this study was to analyze the outcomes of revision surgery following Replantation of single digital amputations. METHODS In this study, first, a total of 403 patients (339 male, 64 female; mean age=28 years; age range=1-76) in whom a single Finger Replantation was performed were retrospectively reviewed, and then 60 patients with arterial or venous insufficiency in whom revision surgery was performed were reanalyzed. The second Finger was observed to be the most injured one (32.8%). Injury type was classified as clean cut (25.3%), local crush (38.7), extensive crush (7.9%), and avulsion (28.1%). When taking the levels of injuries of the artery-only Finger Replantations into account, one Finger (0.8%) was nail distal third, 70 Fingers (56%) were nail distal third to lunula, 43 Fingers (34.4%) were lunula to distal phalanx basis, 10 Fingers (8%) were distal interphalangeal (DIP) joint, and one Finger (0.8%) was middle phalanx. Operative revision was performed on 60 (14.9%) Fingers. The need for operative revision was arterial insufficiency in 37 Fingers (61.7%) and venous insufficiency in 23 Fingers (38.3%). The average revision time was 43 (range=6-144) hours. While the average elapsed time for artery procedures was 35.3 (range=8-110) hours, the average elapsed time for vein procedures was 47.1 (range=6-144) hours. Finger survival rates were examined. Injury mechanism, amputation level, the number of artery/vein repairs and methods were examined in all patients and revision patients separately. RESULTS After the Replantations, according to survival analysis, while 342 (84.9%) Fingers were operated upon successfully, 61 (15.1%) Fingers developed necrosis. In the patients with revision surgery, the survival rate was 78.3%. The need for revision was arterial insufficiency in 37 Fingers (61.7%) and venous insufficiency in 23 Fingers (38.3%). The revision rate was significantly lower than other injury types in clean-cut cases. In terms of levels of injury, no revisions were required from distal to lunula level, and the highest revision rate was observed at the proximal interphalangeal (PIP) joint level. CONCLUSION The results of the present study have shown that early re-exploration can provide a 78.3% success rate and can increase the survival rate from 67.6% to 84.2% following Replantation of single digital amputations. Surgical re-exploration seems to be a reasonable salvage for replanted Fingers with vascular insufficiency. LEVEL OF EVIDENCE Level IV, Therapeutic study.
Jing Shang-fe - One of the best experts on this subject based on the ideXlab platform.
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Clinical research on lateral flap and venous flap in Finger Replantation
Hainan Medical Journal, 2012Co-Authors: Jing Shang-feAbstract:Objective To explore the application of lateral flap and venous flap in Finger Replantation.Methods 36 patients(40 Fingers) scheduled for Finger Replantation admitted in our hospital were randomly divided into two groups,the study group(20 patients,23 Fingers) received lateral flap repair,the control group(16 patients,17 Fingers) received venous flap repair.The patients were followed up for 12～26 months.The recovery of hand function and poor prognosis were compared between the two groups.Results The excellent and good rate were 95.7% in the study group and 94.1% in the control group(P0.05).The incidence of vein crisis and flap necrosis showed no statistically significant difference between the two groups(P0.05),but the deepening of color and the decline of elasticity were better in the study group(P0.05).Conclusion Lateral flap and venous flap in Finger Replantation can significantly improve the clinical efficacy and reduce adverse reactions.