From the TriHealth Hand Surgery Specialists, Cincinnati, OH (Chen), University of Colorado School of Medicine, Aurora, CO (Scott, Ipaktchi, and Lauder), and the Denver Health Medical Center, Denver, CO (Ipaktchi and Lauder).
J Am Acad Orthop Surg. 2021 Aug 1;29(15):e732-e742. doi: 10.5435/JAAOS-D-20-01176.
Successful replantation and revascularization of the hand and digit require a skilled team with urgent access to an operating room with microsurgical capabilities. Although careful indications and surgical techniques contribute to success, postoperative management also plays a vital role in the survival of a replanted digit. Previous research has assessed surgical efficiency and techniques to conduct these procedures, but few studies evaluate postoperative protocols to care for patients undergoing these procedures. Because of the lack of high-level evidence specific to replantation, many common postoperative practices related to monitoring, anticoagulation, and diet have been inferred from elective microsurgical procedures, despite notable differences in operating conditions. The highest level of evidence pertaining to digital replantation was found with the use of peripheral nerve blockade, leeching/bleeding, and nicotine use. This review provides an in-depth evaluation of the literature and insight into the rationale and level of evidence that support each postoperative intervention. It highlights institutional variability and a paucity of high-level evidence pertaining to this topic while identifying the areas of future research.
手部和手指的成功再植和血运重建需要一个熟练的团队，能够紧急进入具备显微外科能力的手术室。尽管仔细的适应证和手术技术有助于成功，但术后管理对于再植手指的存活也起着至关重要的作用。先前的研究评估了进行这些手术的手术效率和技术，但很少有研究评估术后护理方案以照顾接受这些手术的患者。由于缺乏专门针对再植的高级别证据，许多与监测、抗凝和饮食相关的常见术后实践已从选择性显微外科手术中推断出来，尽管手术条件存在显著差异。与手指再植相关的最高级别证据是使用周围神经阻滞、水蛭/出血和尼古丁使用。本综述对文献进行了深入评估，并深入了解支持每个术后干预措施的原理和证据水平。它突出了机构间的差异和缺乏针对这一主题的高级别证据，同时确定了未来研究的领域。
