Stögner Viola Antonia, Megerle Kai, Krezdorn Nicco, Vogt Peter Maria
Department of Plastic, Aesthetic Hand and Reconstructive Surgery, Hannover Medical School, Carl-Neuberg-Straße 1, Hannover 30625, Germany.
Centre for Hand and Elbow Surgery, Schön Clinic München Harlaching, Seestraße 5a, Prien am Chiemsee 83209, Germany.
JPRAS Open. 2022 Feb 21;32:98-110. doi: 10.1016/j.jpra.2022.01.002. eCollection 2022 Jun.
The treatment of traumatic major upper limb amputation is complex and of great urgency. Loss of time often represents a majorrestriction for replantation. Thus, logistical and infrastructural developments, such as the expansion of specialised hand trauma centres, are crucial for optimizing delivery of care. Surveillance represents the fundament for a proper, demand-adapted implementation of such therapeutical improvements. However, a comprehensive database for surveillance of these injuries does currently not exist in Germany or Europe. In this study quality reports of German hospitals from 2014 to 2018 were screened retrospectively for traumatic major upper extremity amputations and replantations. A total of 329 amputations and 87 replantations were recorded, accounting for an overall replantation rate (RR) of 26%. Most of the injuries affected the level of the wrist and forearm. Treatment of these injuries experienced an increasing centralisation to medical teaching facilities, which accounted for higher RRs compared with non-teaching facilities. The cumulatively most populous federal states handled most of the amputation injures in this five-year study period. Ratio calculations on the basis of population counts, however, revealed great discrepancies to these results, with Hamburg, Rhineland-Palatinate and Saarland accounting for the highest per capita incidences. In 2018 Germany was provided with 46 specialised hand trauma and replantation centres, which performed 45% of the replantations in that year, revealing a RR of 17%, compared to an overall RR of 14% in that year. Nevertheless, there might be potential for improvement in the geographical distribution of these specialised centres. The provision of highly specialised therapy in highly specialised centres for highly complex injuries is a future challenge in replantation surgery. This data is contributing to logistical improvements for a need-adapted expansion of these specialised hand trauma centres. The study demonstrates an approach of a standardised and comprehensive injury surveillance program based on national quality reports, while underlining the importance of such a national or rather European database for optimisations in medical care. Level of evidence IV.
创伤性上肢大截肢的治疗复杂且极为紧急。时间延误往往是再植的主要限制因素。因此，后勤和基础设施的发展，如扩大专业手外伤中心，对于优化医疗服务的提供至关重要。监测是合理、按需实施此类治疗改进措施的基础。然而，德国或欧洲目前尚无用于监测这些损伤的综合数据库。在本研究中，对德国医院2014年至2018年的质量报告进行回顾性筛查，以查找创伤性上肢大截肢和再植病例。共记录了329例截肢和87例再植，总体再植率（RR）为26%。大多数损伤发生在腕部和前臂水平。这些损伤的治疗越来越集中于医学教学机构，与非教学机构相比，其再植率更高。在这五年的研究期间，人口累计最多的联邦州处理了大部分截肢损伤病例。然而，基于人口计数的比率计算结果与这些结果存在很大差异，汉堡、莱茵兰-普法尔茨州和萨尔州的人均发病率最高。2018年，德国有46个专业手外伤和再植中心，当年这些中心完成了45%的再植手术，再植率为17%，而当年总体再植率为14%。尽管如此，这些专业中心的地理分布可能仍有改进空间。在高度专业化的中心为高度复杂的损伤提供高度专业化的治疗是再植手术未来面临的挑战。这些数据有助于为按需扩大这些专业手外伤中心进行后勤改进。该研究展示了一种基于国家质量报告的标准化和全面损伤监测计划的方法，同时强调了这样一个国家或欧洲数据库对于优化医疗服务的重要性。证据等级IV。
