Division of Reconstructive Microsurgery, Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Linkou Medical Center and Chang Gung Medical College and Chang Gung University, Taoyuan, Taiwan.
Department of Plastic Surgery, Maastricht University Medical Center, Maastricht, The Netherlands.
J Reconstr Microsurg. 2020 May;36(4):301-310. doi: 10.1055/s-0039-1701013. Epub 2020 Feb 5.
Replantation of a single digit at the distal phalanx level is not routinely performed since it is technically challenging with questionable cost-effectiveness. The purpose of this study was to analyze international microsurgeons' clinical decisions when faced with this common scenario.
A survey of a right-middle finger distal phalanx transverse complete amputation case was conducted via online and paper questionnaires. Microsurgeons around the world were invited to provide their treatment recommendations. In total, 383 microsurgeons replied, and their responses were stratified and analyzed by geographical areas, specialties, microsurgery fellowship training, and clinical experiences.
Among 383 microsurgeons, 170 (44.3%) chose replantation as their preferred management option, 137 (35.8%) chose revision amputation, 62 (16.2%) chose local flap coverage, 8 (2.1%) chose composite graft, and 6 (1.6%) favored other choices as their reconstruction method for the case study. Microsurgeons from the Asia-Pacific, Middle East/South Asia, and Central/South America regions tend to perform replantation (70.7, 68.8, and 67.4%, respectively) whereas surgeons from North America and Europe showed a lower preference toward replantation (20.5 and 26.8%, respectively < 0.001). Having completed a microsurgery fellowship increased the attempt rate of replantation by 15.3% ( = 0.004). Clinical experience and the surgeons' specialties did not show statistical significance in clinical decision making.
From the present study, the geographic preferences and microsurgery fellowship experience influence the method of reconstruction for distal phalanx amputation. Multiple factors are taken into consideration in selecting the most suitable reconstructive method for each case scenario. In addition to the technical challenges of the proposed surgery, the cost of the procedure and the type of facility needed are important variables in the decision making process.
由于技术难度大，且成本效益存在疑问，远端指尖水平的单指再植术通常不常规进行。本研究旨在分析国际显微外科医生在面对这种常见情况时的临床决策。
通过在线和纸质问卷对右手中指远端指节横断完全离断的病例进行调查。邀请世界各地的显微外科医生提供他们的治疗建议。共有 383 名显微外科医生回复，他们的回答按地理位置、专业、显微外科住院医师培训和临床经验进行分层和分析。
在 383 名显微外科医生中，170 名（44.3%）选择再植作为首选治疗方案，137 名（35.8%）选择 Revision 截肢，62 名（16.2%）选择局部皮瓣覆盖，8 名（2.1%）选择复合移植物，6 名（1.6%）选择其他选择作为该病例研究的重建方法。来自亚太地区、中东/南亚和中/南美地区的显微外科医生更倾向于进行再植术（分别为 70.7%、68.8%和 67.4%），而来自北美和欧洲的外科医生则不太倾向于进行再植术（分别为 20.5%和 26.8%）（ < 0.001）。完成显微外科住院医师培训可使再植术的尝试率增加 15.3%（ = 0.004）。临床经验和外科医生的专业并没有在临床决策中显示出统计学意义。
从本研究中可以看出，地理偏好和显微外科住院医师培训经验影响远端指节离断的重建方法。在选择每个病例场景最合适的重建方法时，会考虑多个因素。除了拟议手术的技术挑战外，手术的成本和所需的设施类型也是决策过程中的重要变量。
