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

MedStar author(s):

Citation: Journal of Hand Surgery - American Volume. 46(10):908-916, 2021 10.PMID: 34376294Institution: Curtis National Hand CenterDepartment: MedStar Georgetown University Hospital | Plastic Surgery ResidencyForm of publication: Journal ArticleMedline article type(s): Journal Article | ReviewSubject headings: *Amputation, Traumatic | *Finger Injuries | Amputation | Amputation, Traumatic/su [Surgery] | Finger Injuries/su [Surgery] | Fingers/su [Surgery] | Humans | ReplantationYear: 2021 ISSN:

0363-5023

Name of journal: The Journal of hand surgeryAbstract: 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.All authors: Giladi AM, Harbour PW, Malphrus E, Zimmerman RMOriginally published: Journal of Hand Surgery - American Volume. 2021 Aug 07Fiscal year: FY2022Fiscal year of original publication: FY2022Digital Object Identifier:

https://dx.doi.org/10.1016/j.jhsa.2021.07.007

Date added to catalog: 2021-11-01

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Holdings
Item type	Current library	Collection	Call number	Status	Date due	Barcode
Journal Article	MedStar Authors Catalog	Article	34376294	Available		34376294

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