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.
Resumen
Peer-reviewed clinical and outcomes research relevant to medicinal leech therapy and its biology. Indexed in PubMed and verified against the NCBI record.
Por qué esto importa para la hirudoterapia
Esta serie de 46 replantes digitales consecutivos (2002-2012), recopilada prospectivamente por un único cirujano, reportó una supervivencia global del replante del 82.6% (38/46), una mejora significativa a lo largo del tiempo (p=0.04) y una asociación significativa entre la experiencia quirúrgica microvascular acumulada y el éxito (p<0.001), con un aumento marcado en la odds ratio de supervivencia después de aproximadamente 100 horas de experiencia microvascular (OR 8.5, IC 95% 1.5-47.9), lo que equivale a unos dos años de práctica para este cirujano de alto volumen; las lesiones por aplastamiento y las del pulgar tuvieron peores resultados. Para la hirudoterapia, esto es relevante como contexto debido a que las sanguijuelas medicinales son un complemento reconocido para el manejo de la congestión venosa en dedos replantados y colgajos microvasculares, y el estudio documenta el entorno de habilidad quirúrgica en el que surgen tales decisiones de salvamento. Advertencia: se trata de una serie de casos de un único cirujano que examina explícitamente la curva de aprendizaje del operador, no la terapia con sanguijuelas; no utilizó ni evaluó la hirudoterapia, por lo que sirve únicamente para situar el entorno de replante microquirúrgico donde a veces se emplean las sanguijuelas.
Citación
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
Contexto clínico relacionado
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Añadido a la biblioteca ASH: May 28, 2026 · Última actualización del sitio: June 18, 2026