Hustedt Joshua W, Nystrom N Ake, Champagne Lloyd
Orthopaedic Surgery, University of Arizona College of Medicine, Phoenix, USA.
Plastic Surgery, Stavanger University Hospital, Stavanger, NOR.
Cureus. 2024 Aug 4;16(8):e66133. doi: 10.7759/cureus.66133. eCollection 2024 Aug.
Digital replantation is a technically difficult microsurgery requiring significant surgical skill. The aim of this study was to investigate postoperative outcomes associated with the surgical learning curve for microvascular digital replantation.
A prospectively maintained surgical database of consecutive patients who underwent digital replantation from 2002 to 2012 was reviewed. All cases were performed by a single surgeon and began immediately after the surgeon's fellowship. A total of 46 patients were identified. Outcomes of digital replantation were tested for association with time since fellowship, total microvascular operative experience, and location and type of injury.
Overall, 38/46 (82.6%) of patients underwent a successful digital replantation. There was a significant difference between survival percentages over the years (p=0.04), with improvement seen over time. Total microvascular experience was significantly associated with successful outcomes (p<0.001). After 100 hours of microvascular experience, there was a significant increase in the survival odds ratio (OR 8.5, 95% CI 1.5-47.9). Crush and thumb injuries were more likely to have detrimental outcomes.
There was marked improvement in replant survival over time, with a significant increase in odds of survival after 100 hours of microvascular experience. One hundred operating hours under the microscope occurred around 2 years in practice for this high-volume surgeon. There is strong evidence that a steep learning curve occurs in microvascular digit replantation surgery.
手指再植是一项技术难度大的显微外科手术，需要高超的手术技巧。本研究的目的是调查与微血管手指再植手术学习曲线相关的术后结果。
回顾了一个前瞻性维护的手术数据库，该数据库包含2002年至2012年连续接受手指再植的患者。所有病例均由一名外科医生完成，且该医生在完成 fellowship 后立即开始手术。共确定了46例患者。测试手指再植的结果与 fellowship 后的时间、微血管手术总经验以及损伤的部位和类型之间的关联。
总体而言，46例患者中有38例（82.6%）成功进行了手指再植。多年来的存活百分比存在显著差异（p = 0.04），且随着时间推移有所改善。微血管总经验与成功结果显著相关（p < 0.001）。在积累100小时微血管经验后，存活优势比显著增加（优势比8.5，95%置信区间1.5 - 47.9）。挤压伤和拇指损伤更有可能产生不良后果。
随着时间推移，再植存活率有显著提高，在积累100小时微血管经验后存活几率显著增加。对于这位高手术量的外科医生来说，在实际操作中大约2年时间会积累100小时显微镜下手术时间。有强有力的证据表明微血管手指再植手术存在陡峭的学习曲线。
