Department of Orthopedics, University of Southern California, Los Angeles, California, USA.
Eur J Orthop Surg Traumatol. 2024 Oct;34(7):3661-3668. doi: 10.1007/s00590-023-03671-2. Epub 2023 Aug 18.
Since the advent of replantation techniques, there has been uneven progress in terms of success-even considering whether success is defined as continued perfusion of the digit or long term functional outcomes. Early enthusiasm and success have not been maintained despite increasing familiarity with microsurgical techniques and greater understanding of how to optimize outcomes for the individual components of replantation such as tendon repair, nerve repair, and osteosynthesis. Practitioners participating in the care of patients undergoing replantation should be familiar with the history and current understanding of both the indications and contraindications for the procedure, post-operative rehabilitation, and factors contributing to functional outcomes. A review of the literature from the first publications on the topic demonstrates evolution in practice and understanding of which patients should be indicated for replantation. Indications can be considered in three broad categories: injury factors, patient factors, and care context factors. These factors intersect with one another and can inform the surgeon pre-operatively regarding the most likely outcome for a given patient. This insight is critical to discuss pre-operatively with the patient in order to make a shared decision about how to manage their injury.
自再植技术问世以来，尽管人们越来越熟悉显微外科技术，并进一步了解如何优化再植术各个组成部分（如肌腱修复、神经修复和骨合成）的效果，但在手术成功率方面（即使将成功定义为指的是断指持续灌注还是长期功能结果）仍存在参差不齐的情况。早期的热情和成功并没有得到维持。参与再植术患者护理的从业者应该熟悉该手术的适应证和禁忌证、术后康复以及影响功能结果的因素的历史和当前认识。对该主题的首批出版物的文献综述表明，实践和对哪些患者应接受再植术的认识都在不断发展。适应证可以分为三大类：损伤因素、患者因素和护理环境因素。这些因素相互交叉，可以在术前为外科医生提供有关特定患者最可能结果的信息。这种洞察力对于与患者进行术前讨论至关重要，以便就如何处理他们的损伤做出共同决策。
