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Delayed Digit Replantation: What is the Evidence?. [Review] - 2021

A persistent challenge that has limited access and delivery of digit replantation surgery is timing, as ischemia time has traditionally been considered an important determinant of success. However, reports that the viability of amputated digits decreases after 6 hours of warm ischemia and 12 hours of cold ischemia are largely anecdotal. This review evaluates the quality and generalizability of available evidence regarding ischemia times after digit amputation and reported outcomes of "delayed" replantation. We identify substantial limitations in the literature supporting ischemia time cutoffs and recent evidence supporting the feasibility of delayed digit replantation. The current treatment approach for amputation injuries often necessitates transfers or overnight emergency procedures that increase costs and limit availability of digit replantation nationwide. Evidence-based changes to digit replantation protocols could lead to broader availability of this service, as well as improved care quality. Copyright (c) 2021 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.


English

ISSN: 0363-5023

Subjects--Topical Terms:
*Amputation, Traumatic
*Finger Injuries
Amputation
Amputation, Traumatic/su [Surgery]
Finger Injuries/su [Surgery]
Fingers/su [Surgery]
Humans
Replantation

Subjects--Geographic Terms:
Curtis National Hand Center

Index Terms--Occupation:
MedStar Georgetown University Hospital
Plastic Surgery Residency

Index Terms--Function:
Journal Article
Review