Postoperative Digit and Hand Replantation Protocols: A Review of the Literature
Research article published in J Am Acad Orthop Surg (2021)
Abstract
Successful replantation and revascularization of the hand and digit require a skilled team with urgent access to an operating room with microsurgical capabilities. Although careful indications and surgical techniques contribute to success, postoperative management also plays a vital role in the survival of a replanted digit. Previous research has assessed surgical efficiency and techniques to conduct these procedures, but few studies evaluate postoperative protocols to care for patients undergoing these procedures. Because of the lack of high-level evidence specific to replantation, many common postoperative practices related to monitoring, anticoagulation, and diet have been inferred from elective microsurgical procedures, despite notable differences in operating conditions. The highest level of evidence pertaining to digital replantation was found with the use of peripheral nerve blockade, leeching/bleeding, and nicotine use. This review provides an in-depth evaluation of the literature and insight into the rationale and level of evidence that support each postoperative intervention. It highlights institutional variability and a paucity of high-level evidence pertaining to this topic while identifying the areas of future research.
Abstract sourced from PubMed (NCBI) for the cited record. See the original publication for the authoritative version.
Summary
Review of postoperative protocols for digit and hand replantation; highest level of evidence pertains to peripheral nerve blockade, leeching/bleeding, and nicotine use.
Why This Matters for Hirudotherapy
This review of the literature evaluated postoperative management protocols for hand and digit replantation, covering monitoring, anticoagulation, diet, peripheral nerve blockade, leeching/bleeding, and nicotine use. The authors identified peripheral nerve blockade, leeching/bleeding, and nicotine use as areas with the highest level of evidence in digital replantation postoperative care. The review is relevant to ASH's domain because it directly addresses leeching/bleeding as a postoperative intervention in replantation surgery, providing a connection to hirudotherapy practice. The caveat is that the abstract provides no specific quantitative outcome data for leeching, highlights institutional variability and a paucity of high-level evidence overall, and the exact nature and role of leech therapy is not described in detail.
Citation
Postoperative Digit and Hand Replantation Protocols: A Review of the Literature.
Chen C et al. · J Am Acad Orthop Surg, 2021
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