The Experts below are selected from a list of 15807 Experts worldwide ranked by ideXlab platform
Kevin C. Chung - One of the best experts on this subject based on the ideXlab platform.
-
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.
-
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.
-
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.
-
a population based study of Replantation after traumatic thumb amputation 2007 2012
Journal of Hand Surgery (European Volume), 2017Co-Authors: Elham Mahmoudi, Helen E Huetteman, Kevin C. ChungAbstract:Purpose The recommended surgical treatment after thumb amputation is Replantation. In the United States, fewer than 40% of thumb amputation injuries are replanted, and little is known about factors associated with the probability of Replantation. We aimed to investigate recent trends and examine patient and hospital characteristics that are associated with increased probability of attempted thumb Replantation. We hypothesized that higher-volume teaching hospitals and level-I trauma centers attempted more Replantations. Methods We used 2007–2012 data from the National Trauma Data Bank. Our final sample included 2,206 traumatic thumb amputation patients treated in 1 of 365 centers during the study period. First, we used a 2-level hierarchical logistic model to estimate the odds of Replantation. In addition, we used a treatment effect estimation method, with the inverse propensity score weighting to examine the difference in thumb Replantation if the only variation among patients was their presumptive payer. Results There was a higher probability of attempted Replantation at teaching hospitals than nonteaching hospitals (odds ratio [OR], 1.40). Patients were less likely to undergo Replantation at a level II (OR, 0.53) or a level III (OR, 0.33) trauma center. The uninsured were less likely to undergo Replantation (OR, 0.61) than those with private insurance. Conclusions Having insurance coverage and being treated in a high-volume, teaching, level-I trauma hospital increased the odds of Replantation after traumatic thumb amputation. Regionalization may lead to a higher number of indicated cases of Replantation actually being attempted. Type of study/level of evidence Therapeutic II.
-
the effect of medicaid expansion on delivery of finger and thumb Replantation care to medicaid beneficiaries and the uninsured
Plastic and Reconstructive Surgery, 2015Co-Authors: Aviram M Giladi, Oluseyi Aliu, Kevin C. ChungAbstract:BACKGROUND Despite advances in Replantation, over 80 percent of finger and thumb amputation injuries in the United States result in revision amputation. Although numerous factors contribute to this, disparities in access and delivery of Replantation care play a substantial role. With ongoing Medicaid expansion under the Affordable Care Act, it is prudent to understand whether expansion of coverage changes use of Replantation care. METHODS The authors used the 2001 Medicaid expansion in New York State to evaluate changes in Replantation for Medicaid beneficiaries and the uninsured. Data for patients having undergone Replantation between 1998 and 2006 were obtained from the New York State Inpatient Database. The authors used an interrupted time series to evaluate the effect of Medicaid expansion on the probability that Medicaid beneficiaries or uninsured patients underwent Replantation. Census data were used for population-adjusted case volume analysis. RESULTS After expansion, the likelihood of Medicaid as the primary payer for Replantation increased 0.0059 percent per quarter, reaching a 1.7 percent increase 5 years after expansion. With population-based analysis, this indicates that Medicaid covered 12 additional Replantation cases in New York State annually. After expansion, 11 fewer of the Replantation cases in New York State each year were provided to patients without health care coverage. CONCLUSIONS Medicaid expansion resulted in a modest but significant increase in Replantation for Medicaid beneficiaries. In addition, fewer patients that underwent Replantation remained uninsured. Considering the substantial cost and effort burden of Replantation, these findings support the benefits of Medicaid expansion on delivery and payer coverage of Replantation.
Panayotis N. Soucacos - One of the best experts on this subject based on the ideXlab platform.
-
Major limb Replantation in children.
Microsurgery, 1994Co-Authors: Alexandros E. Beris, Panayotis N. Soucacos, Konstantinos N. Malizos, Gregory MitsionisAbstract:After the first successful Replantation of a completely amputated extremity in a 12-year-old boy undertaken by Ronald Malt at the Massachusetts General Hospital in 1962 (Malt and McKhann, Journal of the American Medical Association, 189:716–722, 1964) numerous series of major limb Replantations have been reported in adults. The reports of major limb Replantation in children are relatively rare and are usually included in adult series. During the last 14 years, 18 children with major limb amputations were treated at the Microsurgical and Replantation Unit of the Department of Orthopaedic Surgery at the University of Ioannina Medical School. Of these, 13 were complete amputations (11 upper extremity and 2 lower extremity), while 5 were incomplete nonviable amputations (3 upper extremity and 2 lower extremity). The success rate following Replantation of the complete amputations was 76.9%, while for the incomplete, nonviable amputations success was 80%. Preoperative evaluation, operative management, postoperative care, and the results of this difficult but rewarding procedure are analysed and discussed in this review. © 1994 Wiley-Liss, Inc.
Fatih Kabakas - One of the best experts on this subject based on the ideXlab platform.
-
Dorsal approach for vascular repairs in distal finger Replantations
Microsurgery, 2016Co-Authors: Fatih KabakasAbstract:INTRODUCTION Distal finger Replantations are technically difficult operations due to small vessel sizes and narrow field of vision. The results of 25 distal finger Replantations performed by dorsal approach are presented. The technical benefits and details of this technique is discussed with a literature review. PATIENTS AND METHODS Twenty-five distal finger Replantations were performed by dorsal approach. In dorsal approach volar skin was repaired first and arterial and venous repairs were performed from dorsal side before bone fixation and nailbed repair. Twenty-one cases were Tamai zone I amputations 4 cases were Tamai zone II amputations. 3 amputations were in children and the other patients were adults. Nine amputations were transverse type and the others were oblique amputations. RESULTS Twenty-three fingers survived and 2 fingers were lost despite revision surgeries (92% success rate). Dorsal approach provided about 2 times wider exposures compared to the volar approach. Fourteen patients had external bleeding to prevent congestion. Mean duration of external bleeding was 6.8 days (range, 6 - 8 days). Mean hospitalization period was 7.7 days (range, 6 - 10 days). The mean follow up period was 13 months (range, 6 - 28 months). Six patients had nail deformity. Four patients had pulp atrophy. Three patients had restriction of range of motion in distal interphalangeal joint. CONCLUSION Dorsal approach provides a better exposure of vessel repair sites without tension and helps in technical difficulties of distal finger Replantation. All types of distal finger amputations are amenable to dorsal approach for vascular repairs and oblique amputations are ideal ones. © 2016 Wiley Periodicals, Inc. Microsurgery, 2016. © 2015 Wiley Periodicals, Inc. Microsurgery 36:628-636, 2016.
-
Advantages of using volar vein repair in finger Replantations
Journal of plastic reconstructive & aesthetic surgery : JPRAS, 2013Co-Authors: Berkan Mersa, Fatih Kabakas, Hüsrev Purisa, Ismail Bulent Ozcelik, Nebil Yeşiloğlu, Ilker Sezer, Serdar TunçerAbstract:Providing adequate venous outflow is essential in finger Replantation surgeries. For a successful result, the quality and quantity of venous repairs should be adequate to drain arterial inflow. The digital dorsal venous plexus is a reliable source of material for venous repairs. Classically, volar digital veins have been used only when no other alternative was available. However, repairing volar veins to augment venous outflow has a number of technical advantages and gives a greater chance of survival. Increasing the repaired vein:artery ratio also increases the success of Replantation. The volar skin, covering the volar vein, is less likely to be avulsed during injury and is also less likely to turn necrotic, than dorsal skin, after the Replantation surgery. Primary repair of dorsal veins can be difficult due to tightness ensuing from arthrodesis of the underlying joint in flexion. In multiple finger Replantations, repairing the volar veins after arterial repair and continuing to do so for each finger in the same way without changing the position of the hand and surgeon save time. In amputations with tissue loss, the size discrepancy is less for volar veins than for dorsal veins. We present the results of 366 finger Replantations after volar vein repairs.
Murat Kayalar - One of the best experts on this subject based on the ideXlab platform.
-
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.
-
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.
-
Survival and Comparison of External Bleeding Methods in Artery-Only Distal Finger Replantations.
The Journal of hand surgery, 2019Co-Authors: Murat Kayalar, Özgün Barış Güntürk, Tulgar Toros, Yusuf Gürbüz, Tahir Sadik Sugun, Yalcin AdemogluAbstract:Purpose If there are no veins available in a distal amputation, an artery-only Replantation is performed, and an external bleeding method is commonly used. We conducted a survival analysis in a large series of artery-only Replantations and compared 2 different external bleeding methods in artery-only distal Replantations: nail matrix or hyponychial area bleeding and pulp skin area bleeding, which we have called the crater method. Methods Two hundred twenty-eight artery-only distal finger Replantations in 199 patients were included in the study. The replanted digits were divided into 2 groups according to the external bleeding methods. One group (n = 94; 41.2%) included the patients in whom the external bleeding was performed using a traditional nail bed incision and the second group (n = 134; 58.8%) included the patients in whom external bleeding was performed using the crater method. The finger survival rates and postoperative circulatory problems were examined. The impact of the injury mechanism, injury level, and external bleeding method on survival were evaluated. Results Clinical findings indicating venous insufficiency were observed in 198 (86.8%) replanted fingers. One hundred eighty-two (79.8%) survived, and complete necrosis developed in 46 (20.2%). Viability was maintained in 84% of patients treated with the nail bed bleeding method and 76.9% of patients treated using the crater method. Clean-cut cases had the best results and subzone 3 cases had the worst results. Conclusions The artery-only Replantation was associated with a 79.8% survival rate. The method of achieving venous outflow did not appear to have an impact on survival. Type of study/level of evidence Therapeutic IV.
Yusuf Gürbüz - One of the best experts on this subject based on the ideXlab platform.
-
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.
-
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.
-
Survival and Comparison of External Bleeding Methods in Artery-Only Distal Finger Replantations.
The Journal of hand surgery, 2019Co-Authors: Murat Kayalar, Özgün Barış Güntürk, Tulgar Toros, Yusuf Gürbüz, Tahir Sadik Sugun, Yalcin AdemogluAbstract:Purpose If there are no veins available in a distal amputation, an artery-only Replantation is performed, and an external bleeding method is commonly used. We conducted a survival analysis in a large series of artery-only Replantations and compared 2 different external bleeding methods in artery-only distal Replantations: nail matrix or hyponychial area bleeding and pulp skin area bleeding, which we have called the crater method. Methods Two hundred twenty-eight artery-only distal finger Replantations in 199 patients were included in the study. The replanted digits were divided into 2 groups according to the external bleeding methods. One group (n = 94; 41.2%) included the patients in whom the external bleeding was performed using a traditional nail bed incision and the second group (n = 134; 58.8%) included the patients in whom external bleeding was performed using the crater method. The finger survival rates and postoperative circulatory problems were examined. The impact of the injury mechanism, injury level, and external bleeding method on survival were evaluated. Results Clinical findings indicating venous insufficiency were observed in 198 (86.8%) replanted fingers. One hundred eighty-two (79.8%) survived, and complete necrosis developed in 46 (20.2%). Viability was maintained in 84% of patients treated with the nail bed bleeding method and 76.9% of patients treated using the crater method. Clean-cut cases had the best results and subzone 3 cases had the worst results. Conclusions The artery-only Replantation was associated with a 79.8% survival rate. The method of achieving venous outflow did not appear to have an impact on survival. Type of study/level of evidence Therapeutic IV.