Chia Dawn Sinn Yii, Tay Shian Chao
Hand and Microsurgery Section, Department of Orthopaedics, Tan Tock Seng Hospital, Singapore 308433, Singapore.
Hand Surg. 2015;20(1):127-32. doi: 10.1142/S0218810415500185.
Replantation surgery is an established treatment for amputated digits, and published literature report a high success rate. However, a proportion of replantations do encounter postoperative problems with vascularity, but the incidence is unknown. Although there are studies that look at the factors affecting the success of replantations and the management of postoperative replantations, there is little literature available on this transitional period. We introduce the term "troubled replantation" to describe the replantation that manifests any form of vascular insufficiency after replantation surgery. Our study focuses on reviewing our centre's experience with the management and outcomes of troubled replantations.
Data was collected retrospectively from 389 digital replantations performed in our centre over an 11 year period. We included only single level digital replantations. We analysed the perioperative data, and the measures taken postoperatively to promote their survival.
There were a total of 137 troubled digits (35.2%). 53 digits responded to non-surgical measures such as dressing change and bedside bleeding procedures. 27 digits required re-exploration surgery, of which 16 survived. The majority of troubled replantations were due to arterial causes, and manifested signs within the first 48 h. 69 troubled digits (51%) survived. The remainder did not respond to any form of treatment including re-explorations and ultimately failed.
One third of all replantations are troubled replantations, and half of these eventually fail despite any intervention. As troubled replantations can lead to postoperative failure, it is important to understand this clinical scenario in order to improve immediate postoperative care.
再植手术是治疗断指的一种成熟方法，已发表的文献报道成功率很高。然而，一部分再植手术确实会在术后出现血管方面的问题，但其发生率尚不清楚。尽管有研究探讨了影响再植成功的因素以及术后再植的处理方法，但关于这个过渡阶段的文献却很少。我们引入“问题再植”这一术语来描述再植手术后出现任何形式血管功能不全的情况。我们的研究重点是回顾我们中心处理问题再植的经验及结果。
回顾性收集我们中心在11年期间进行的389例断指再植手术的数据。我们仅纳入单平面断指再植病例。我们分析了围手术期数据以及术后为促进其存活所采取的措施。
共有137个手指出现问题（35.2%）。53个手指对换药和床边放血等非手术措施有反应。27个手指需要再次手术探查，其中16个存活。大多数问题再植是由动脉原因引起的，且在前48小时内出现症状。69个出现问题的手指（51%）存活。其余手指对包括再次探查在内的任何治疗形式均无反应，最终失败。
所有再植手术中有三分之一是问题再植，其中一半尽管进行了任何干预最终仍失败。由于问题再植可能导致术后失败，了解这种临床情况对于改善术后即时护理很重要。
