Current Trends in Digital Replantation-a Narrative Review

Overview

Journal Ann Transl Med

Publisher AME Publishing Company

Date 2024 Aug 9

PMID 39118941

Authors

Min Kai Chang

Jin Xi Lim

Sandeep Jacob Sebastin

Affiliations

Soon will be listed here.

Abstract

Background And Objective: 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.

Methods: 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.

Key Content And Findings: 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.

Conclusions: 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.

Citing Articles

Digital Replantation In Hours Versus Out of Hours: A Retrospective Review of Outcomes.

Holland J, Kuo I, White M, Borsky K, Moura F, Rees-Goddard R Cureus. 2024; 16(11):e73965.

PMID: 39563688 PMC: 11574575. DOI: 10.7759/cureus.73965.

References

Thomson C, Lalonde D . Randomized double-blind comparison of duration of anesthesia among three commonly used agents in digital nerve block. Plast Reconstr Surg. 2006; 118(2):429-32. DOI: 10.1097/01.prs.0000227632.43606.12. View

Chang J, Jones N . Twelve simple maneuvers to optimize digital replantation and revascularization. Tech Hand Up Extrem Surg. 2006; 8(3):161-6. DOI: 10.1097/01.bth.0000134711.75677.3b. View

Chiu H, Chen M . Revascularization of digits after thirty-three hours of warm ischemia time: a case report. J Hand Surg Am. 1984; 9A(1):63-7. DOI: 10.1016/s0363-5023(84)80186-0. View

Waikakul S, Sakkarnkosol S, Vanadurongwan V . Results of 1018 digital replantations in 552 patients. Injury. 2000; 31(1):33-40. DOI: 10.1016/s0020-1383(99)00196-5. View

Kobayashi K, Shinoura S, Nishimura K, Sugawara R . Selection Bias in Avoiding Vein Graft in Replantation/Revascularization May Exist in Distal and Proximal Amputations, Respectively. Plast Reconstr Surg Glob Open. 2023; 11(5):e4992. PMC: 10208696. DOI: 10.1097/GOX.0000000000004992. View

Hyza P, Vesely J, Drazan L, Stupka I, Ranno R, Castagnetti F . Primary vein grafting in treatment of ring avulsion injuries: a 5-year prospective study. Ann Plast Surg. 2007; 59(2):163-7. DOI: 10.1097/01.sap.0000252717.88972.01. View

Wong J, Lin C, Chang N, Chen H, Lin Y, Hsu C . Digital revascularization and replantation using the wide-awake hand surgery technique. J Hand Surg Eur Vol. 2017; 42(6):621-625. DOI: 10.1177/1753193417703516. View

Tamai S . Twenty years' experience of limb replantation--review of 293 upper extremity replants. J Hand Surg Am. 1982; 7(6):549-56. DOI: 10.1016/s0363-5023(82)80100-7. View

Galanakos S, Bot A, Zoubos A, Soucacos P . Psychological and social consequences after reconstruction of upper extremity trauma: methods of detection and management. J Reconstr Microsurg. 2013; 30(3):193-206. DOI: 10.1055/s-0033-1361838. View

10.

Nikolis A, Tahiri Y, St-Supery V, Harris P, Landes G, Lessard L . Intravenous heparin use in digital replantation and revascularization: The Quebec Provincial Replantation program experience. Microsurgery. 2011; 31(6):421-7. DOI: 10.1002/micr.20900. View

11.

Lalonde D . Ten Questions About Wide Awake Local Anaesthesia No Tourniquet (WALANT) Surgery. J Hand Surg Asian Pac Vol. 2022; 27(2):219-225. DOI: 10.1142/S2424835522300031. View

12.

Middleton S, Jenkins P, Muir A, Anakwe R, McEachan J . Variability in local pressures under digital tourniquets. J Hand Surg Eur Vol. 2013; 39(6):637-41. DOI: 10.1177/1753193413492059. View

13.

Boulas H . Amputations of the fingers and hand: indications for replantation. J Am Acad Orthop Surg. 1998; 6(2):100-5. DOI: 10.5435/00124635-199803000-00004. View

14.

Puhaindran M, Paavilainen P, Tan D, Peng Y, Lim A . Dermal pocketing following distal finger replantation. J Plast Reconstr Aesthet Surg. 2009; 63(8):1318-22. DOI: 10.1016/j.bjps.2009.06.039. View

15.

Arata J, Ishikawa K, Soeda H . Replantation of fingertip amputation by palmar pocket method in children. Plast Reconstr Surg. 2011; 127(3):78e-80e. DOI: 10.1097/PRS.0b013e3182063665. View

16.

Tang J, Wang Z, Chen J, Wong J . A Global View of Digital Replantation and Revascularization. Clin Plast Surg. 2017; 44(2):189-209. DOI: 10.1016/j.cps.2016.11.003. View

17.

Ikeda K, Morikawa S, Hashimoto F, Tomita K . Fingertip replantation: pre-osteosynthesis vein graft technique. Microsurgery. 1994; 15(6):430-2. DOI: 10.1002/micr.1920150612. View

18.

Janezic T, Arnez Z, Solinc M . Functional results of 46 thumb replantations and revascularisations. Microsurgery. 1996; 17(5):264-7. DOI: 10.1002/(SICI)1098-2752(1996)17:5<264::AID-MICR5>3.0.CO;2-J. View

19.

Kour A, Phone M, Chia J, Pho R . Digital replantations under local anaesthesia. Ann Acad Med Singap. 1995; 24(4 Suppl):68-72. View

20.

Mihara M, Nakanishi M, Nakashima M, Narushima M, Gonda K, Koshima I . Distal phalanx replantation using the delayed venous method: a high success rate in 21 cases without specialised technique. J Plast Reconstr Aesthet Surg. 2007; 61(1):88-93. DOI: 10.1016/j.bjps.2007.02.004. View