Altam Abdulfattah, Obadiel Yasser, Alazaiza Rami Salim, Alshujaa Mohamed Ali, Alhajami Faris, Ahmed Faisal, Al-Naggar Abdullah Mohammed, Albushtra Ahmed Mohamed, Badheeb Mohamed
Department of General Surgery, School of Medicine, 21 September University, Sana'a, Yemen.
Department of General Surgery, School of Medicine, Sana'a University, Sana'a, Yemen.
Open Access Emerg Med. 2024 Jan 3;16:1-13. doi: 10.2147/OAEM.S443219. eCollection 2024.
This article aims to share our experiences with microsurgical finger replantation in a resource-limited setting.
This multi-institutional, retrospective study included 21 cases of finger amputation that underwent microsurgical replantation, within 7 years period. Patient demographics, preoperative assessments, surgical approaches, and outcomes were documented and analyzed. A univariate analysis was performed to obtain factors associated with digit reimplantation failure.
Out of 21 cases included, 8 (38.1%) had complete amputations and 13 (61.9%) had incomplete amputations. Crush injuries accounted for the majority (71.4%). On average, 2.2 ± 1.1 digits were affected, with the ring finger being the most commonly injured (71.4%). The mean operative time was 121.5 ± 26.8 minutes. The success rate of digit replantation was 76.2%. During a mean follow-up of 14.3 ± 3.7 months, 85.7% of successfully replanted digits considered their replantation results satisfactory. The majority of replanted digits demonstrated active and effective holding and grasping abilities without pain or instability (76.2%). Replantation failure was associated with a higher number of affected digits (p < 0.001), longer operative time (p = 0.004), complete avulsion (p = 0.003), current smoking (p = 0.025), diabetes (p = 0.006), hypertension (p = 0.047), procedure difficulty score (p= 0.004), and occurrence of complications (p < 0.001).
Microsurgical finger replantation can yield favorable outcomes and acceptable survival rates, even within resource-limited settings. However, this procedure requires specialized equipment and personnel that may not be available at all institutions. Influential factors in digit replantation failure, include an increased number of damaged digits, extended operative duration, complete avulsion, current smoking, diabetes, hypertension, procedure difficulty score, and postoperative complications occurrence.
本文旨在分享我们在资源有限的情况下进行显微外科手指再植的经验。
这项多机构回顾性研究纳入了7年内接受显微外科再植的21例手指离断病例。记录并分析了患者的人口统计学资料、术前评估、手术方法和结果。进行单因素分析以获得与断指再植失败相关的因素。
在纳入的21例病例中，8例（38.1%）为完全离断，13例（61.9%）为不完全离断。挤压伤占大多数（71.4%）。平均受影响手指数为2.2±1.1个，其中无名指最常受伤（71.4%）。平均手术时间为121.5±26.8分钟。断指再植成功率为76.2%。在平均14.3±3.7个月的随访期间，85.7%成功再植的手指认为其再植结果令人满意。大多数再植手指表现出主动有效的握持和抓握能力，无疼痛或不稳定（76.2%）。再植失败与受影响手指数量较多（p<0.001）、手术时间较长（p=0.004）、完全撕脱（p=0.003）、当前吸烟（p=0.025）、糖尿病（p=0.006）、高血压（p=0.047）、手术难度评分（p=0.004）以及并发症的发生（p<0.001）相关。
即使在资源有限的情况下，显微外科手指再植也能产生良好的效果和可接受的存活率。然而，该手术需要专门的设备和人员，并非所有机构都具备。断指再植失败的影响因素包括受损手指数量增加、手术时间延长、完全撕脱、当前吸烟、糖尿病、高血压、手术难度评分以及术后并发症的发生。
