Anesthesiology Department, Hospital Parc Taulí, C/Parc del Taulí, 1, 08208, Barcelona, Spain.
Anesthesiology Department, Hospital Clínic Barcelona, C/Carrer Villarroel, 170, 08036, Barcelona, Spain.
Eur J Trauma Emerg Surg. 2021 Feb;47(1):225-232. doi: 10.1007/s00068-019-01226-x. Epub 2019 Sep 24.
Success rate in replantation/revascularization digital surgery is one of the challenges of reconstructive surgery. For this reason, investigating prognostic factors for survival and improvement of outcomes is highly relevant. The goal of this study was to establish predictive factors of survival in replantation/revascularization digital surgery.
A descriptive, retrospective study was performed in patients who underwent urgent replantation/revascularization digital surgery in our center between January 2007 and July 2017. A total of 116 patients and 157 digits were included. Outcome (survival) factors evaluated were: preoperatively: age, sex, body mass index (BMI), ASA anesthesia score, comorbidities (smoking status, diabetes mellitus, hypertension), coagulation, type of lesion, number of affected digits, position of affected digits, injury mechanism, ischemia time; time between accident and the surgery; intraoperatively: anesthetic technique, fluid therapy (administered volume), length of surgery; and postoperatively: post-surgical complications, re-intervention requirements, surgical success rate. Statistical analysis was performed to evaluate outcome and elicit predictive factors.
157 digits from a total of 116 patients were included. Statistically significant differences regarding predictors of survival of replantation were found in ischemia time (0 0.003), length of surgery (p 0.004), post-surgical complications (p 0.000) and replantation need (p 0.000). The rest of analyzed variables were not statistically significant (p > 0.05). Revascularization surgery had a greater success rate than replantation (p 0.001).
Success rate in traumatic digital surgery is greater when revascularization surgery is performed, rather than replantation. Preoperative ischemia time, length of surgery, postoperative complications and re-intervention requirement are the factors that affect survival rate.
再植/血运重建数字手术的成功率是重建手术面临的挑战之一。因此，研究与生存率和结果改善相关的预后因素具有重要意义。本研究的目的是确定再植/血运重建数字手术中生存的预测因素。
对 2007 年 1 月至 2017 年 7 月在我中心行紧急再植/血运重建数字手术的患者进行描述性、回顾性研究。共纳入 116 例患者，157 个手指。评估的结局（生存）因素包括：术前：年龄、性别、体重指数（BMI）、ASA 麻醉评分、合并症（吸烟状况、糖尿病、高血压）、凝血功能、损伤类型、受累手指数量、受累手指位置、损伤机制、缺血时间；事故与手术之间的时间；术中：麻醉技术、液体疗法（给予的体积）、手术时间；术后：术后并发症、再次干预需求、手术成功率。进行统计学分析以评估结局并得出预测因素。
共纳入 116 例患者的 157 个手指。缺血时间（0.003）、手术时间（p=0.004）、术后并发症（p=0.000）和再植需求（p=0.000）与再植生存率的预测因素有统计学显著差异。分析的其他变量无统计学意义（p>0.05）。血运重建手术的成功率高于再植（p=0.001）。
当进行血运重建手术而不是再植时，创伤性手指手术的成功率更高。术前缺血时间、手术时间、术后并发症和再次干预需求是影响生存率的因素。
