Holland James, Kuo Ivy, White Malin, Borsky Kim, Moura Francisco, Rees-Goddard Remy, McGuiness Caroline
Plastic Surgery, Salisbury District Hospital, Salisbury, GBR.
Cureus. 2024 Nov 19;16(11):e73965. doi: 10.7759/cureus.73965. eCollection 2024 Nov.
The British Society for Surgery of the Hand's (BSSH) Getting It Right First Time (GIRFT) guidelines recommend that surgery for traumatic amputations of the digits is ideally performed during normal working hours even if this results in a delay of up to 24 hours.
To compare current practice against the BSSH GIRFT guideline regarding the timing of digital replantation and to compare the success rate of replantation performed within working hours (same or next day) and outside of working hours.
A single-centre retrospective analysis of two years of digital replantation was performed. A comparison was made between success rate of those operated within and outside of normal working hours. Secondary outcomes included operating time, rate of revision surgery, rate of interposition vein grafting, and the effect of the mechanism of injury on success rate.
A total of 32 digital replantation attempts were included in 21 patients. 71.9% of cases (n=23) were performed within normal working hours, demonstrating good compliance with GIRFT guidelines. The success rate of digital replantation attempts was 68.8% overall (n=22). The success rate of same day in hours replantation was 66.7% (n=6), 78.6% (n=11) for next day in hours replantation, and 55.6% (n=5) for digital replantation attempts made out of hours. Revision surgery was required in 28.13% of all replant attempts (n=9). 55.56% (n=5) of cases requiring revision were ultimately successful. The rate of vein graft use was highest in cases taking place same day in hours (75%; n=3) and lowest in cases same day out of hours (22% n=2). The average operating time per digit was 5.5 hours for same day in hours cases, 4.8 hours for next day in hours cases, and 7.1 hours for out of hours cases.
Digital replantation during normal working hours was associated with higher success rate although no statistically significant difference was observed between timing groups. Replantation during normal working hours was associated with shorter operating time per digit, and lower revision rate, although statistical testing was not performed.
英国手外科学会（BSSH）的“首次就做对”（GIRFT）指南建议，手指创伤性截肢手术理想情况下应在正常工作时间进行，即便这会导致长达24小时的延迟。
将当前关于断指再植时机的实践与BSSH的GIRFT指南进行比较，并比较在工作时间内（当天或次日）和工作时间外进行再植的成功率。
对两年内的断指再植进行单中心回顾性分析。比较正常工作时间内和工作时间外手术的成功率。次要结果包括手术时间、翻修手术率、静脉移植率以及损伤机制对成功率的影响。
21例患者共进行了32次断指再植尝试71.9%（n = 23）的病例在正常工作时间内进行，显示出对GIRFT指南较高的依从性。断指再植尝试的总体成功率为68.8%（n =22）。当天工作时间内再植成功率为66.7%（n =6），次日工作时间内再植成功率为78.6%（n =11），工作时间外断指再植尝试成功率为55.6%（n =5）。所有再植尝试中有28.13%（n =9）需要进行翻修手术。需要翻修的病例中有55.56%（n =5）最终成功。静脉移植率在当天工作时间内的病例中最高（75%；n =3），在当天工作时间外的病例中最低（22%；n =2）。当天工作时间内病例每根手指的平均手术时间为5.5小时，次日工作时间内病例为4.8小时，工作时间外病例为7.1小时。
正常工作时间内进行断指再植成功率较高，尽管各时间组之间未观察到统计学上的显著差异。正常工作时间内再植每根手指的手术时间较短，翻修率较低，尽管未进行统计学检验。
