Chang Min Kai, Lim Jin Xi, Sebastin Sandeep Jacob
Department of Hand and Reconstructive Microsurgery, National University Health System, Singapore, Singapore.
Ann Transl Med. 2024 Aug 1;12(4):66. doi: 10.21037/atm-23-1515. Epub 2024 Feb 23.
Digital replantation for traumatic amputation has become the standard of care with advances in microsurgical techniques and technology. While digital replantation has progressed significantly, there are still gaps in knowledge in many aspects. Some of the controversial topics in digital replantation include the indications and contraindications, anesthesia, number of vessel anastomoses, mechanism of injury, role of vein graft, distal fingertip replantation, and postoperative management. This article is a narrative review that discusses these controversies and current issues pertaining to digital replantation.
PubMed, Web of Science, and Google scholar were searched using keywords relating to "digit replantation", "amputation", and "digital replant" with the following terms: "indications", "contraindications", "anaesthesia", "survival", "vessels", "mechanism of injury", "vein graft", "outcome", and "thrombophylaxis". Relevant articles pertaining to digital replantation and deemed by the authors as current or controversial were included.
The reported survival rates of digital replantation are high. With the advancement of microsurgical techniques and technology, the boundaries of digital replantation continue to be pushed. Various methods have been described recently to improve the success rates of difficult replants, such as strategies for venous outflow and vein grafting. However, there are still aspects of digital replantation that remain unanswered, such as the number of veins to anastomose and the thromboprophylaxis regime.
The review delves into controversial aspects of digital replantation, including contraindications, anesthesia, and postoperative management. Indications and contraindications will continue to evolve alongside advancements in microsurgical techniques and anesthesia. It highlights key factors influencing survival rates, such as the number of repaired vessels and the mechanism of injury. Finally, the review consolidates strategies for managing challenging digital replantations.
随着显微外科技术和科技的进步，创伤性断指再植已成为标准治疗方法。虽然断指再植取得了显著进展，但在许多方面仍存在知识空白。断指再植中的一些争议话题包括适应证与禁忌证、麻醉、血管吻合数量、损伤机制、静脉移植的作用、指尖远端再植以及术后管理。本文是一篇叙述性综述，讨论了这些与断指再植相关的争议和当前问题。
使用与“手指再植”“截肢”和“断指再植”相关的关键词在PubMed、科学网和谷歌学术上进行搜索，搜索词如下：“适应证”“禁忌证”“麻醉”“存活”“血管”“损伤机制”“静脉移植”“结果”和“血栓预防”。纳入了与断指再植相关且被作者认为是当前或有争议的相关文章。
报道的断指再植存活率很高。随着显微外科技术和科技的进步，断指再植的界限不断被突破。最近描述了各种提高困难再植成功率的方法，如静脉流出策略和静脉移植。然而，断指再植的一些方面仍未得到解答，如要吻合的静脉数量和血栓预防方案。
该综述深入探讨了断指再植的争议方面，包括禁忌证、麻醉和术后管理。适应证和禁忌证将随着显微外科技术和麻醉的进步而不断演变。它强调了影响存活率的关键因素，如修复血管的数量和损伤机制。最后，该综述整合了处理具有挑战性的断指再植的策略。
