The Learning Curve in Digital Replant Surgery: 46 Prospectively Collected Cases From a Single Surgeon Over a 10-Year Period
Research article published in Cureus (2024)
Abstract
PURPOSE: Digital replantation is a technically difficult microsurgery requiring significant surgical skill. The aim of this study was to investigate postoperative outcomes associated with the surgical learning curve for microvascular digital replantation. METHODS: A prospectively maintained surgical database of consecutive patients who underwent digital replantation from 2002 to 2012 was reviewed. All cases were performed by a single surgeon and began immediately after the surgeon's fellowship. A total of 46 patients were identified. Outcomes of digital replantation were tested for association with time since fellowship, total microvascular operative experience, and location and type of injury. RESULTS: Overall, 38/46 (82.6%) of patients underwent a successful digital replantation. There was a significant difference between survival percentages over the years (p=0.04), with improvement seen over time. Total microvascular experience was significantly associated with successful outcomes (p<0.001). After 100 hours of microvascular experience, there was a significant increase in the survival odds ratio (OR 8.5, 95% CI 1.5-47.9). Crush and thumb injuries were more likely to have detrimental outcomes. CONCLUSIONS: There was marked improvement in replant survival over time, with a significant increase in odds of survival after 100 hours of microvascular experience. One hundred operating hours under the microscope occurred around 2 years in practice for this high-volume surgeon. There is strong evidence that a steep learning curve occurs in microvascular digit replantation surgery.
Abstract sourced from PubMed (NCBI) for the cited record. See the original publication for the authoritative version.
Summary
Peer-reviewed clinical and outcomes research relevant to medicinal leech therapy and its biology. Indexed in PubMed and verified against the NCBI record.
Why This Matters for Hirudotherapy
This prospectively collected single-surgeon series of 46 consecutive digital replantations (2002-2012) reported 82.6% (38/46) overall replant survival, a significant improvement over time (p=0.04), and a significant association between accumulated microvascular operative experience and success (p<0.001), with a marked rise in the survival odds ratio after about 100 hours of microvascular experience (OR 8.5, 95% CI 1.5-47.9), roughly two years in practice for this high-volume surgeon; crush and thumb injuries fared worse. For hirudotherapy this is relevant as context because medicinal leeches are a recognized adjunct for managing venous congestion in replanted digits and microvascular flaps, and the study documents the surgical-skill setting in which such salvage decisions arise. Caveat: this is a single-surgeon case series explicitly examining the operator learning curve, not leech therapy; it neither used nor evaluated hirudotherapy, so it serves only to situate the microsurgical replant setting where leeches are sometimes employed.
Citation
The Learning Curve in Digital Replant Surgery: 46 Prospectively Collected Cases From a Single Surgeon Over a 10-Year Period.
Hustedt JW et al. · Cureus, 2024
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