Multiple venous anastomoses decrease the need for intensive postoperative management in Tamai zone I replantations
Retrospective cohort published in Arch Plast Surg (2017)
Abstract
BACKGROUND: Venous anastomosis is an important component of digital replantation, but is not always feasible, as some cases require external bleeding to treat venous congestion in the replanted tissue. In the present study, we evaluated the relationship between the number of vein anastomoses and the survival rate of Tamai zone I replantations. METHODS: A retrospective review was performed of all patients who underwent replantation of a fingertip amputation between 2014 and 2016. Patient charts were reviewed for demographic information, the mechanism of injury, the number of venous anastomoses, and the use of anticoagulation, external bleeding, and/or leeches. The cohort was divided into 3 groups depending on the number of venous anastomoses: no veins (group 1), a single vein (group 2), and 2 or more veins (group 3). Survival rates and external bleeding rates were analyzed across the groups. RESULTS: The review identified 143 fingertip replantations among 134 patients. The overall survival rate was 94% (135 of 143). Failures were due equally to venous complications (n=4, 50%) and to arterial complications (n=4, 50%). Our analysis did not identify any correlation between the number of veins anastomosed and the replant survival rate (P=0.689). However, a greater number of anastomoses was associated with a significantly lower frequency of external bleeding (P=0.017). CONCLUSIONS: The number of venous anastomoses was not correlated with the survival rate. However, a greater number of venous anastomoses was associated with a decreased need for external bleeding, corresponding to a significant decrease in the need for postoperative monitoring and leech therapy.
Abstract sourced from PubMed (NCBI) for the cited record. See the original publication for the authoritative version.
Резюме
143 fingertip replantations: greater number of vein anastomoses correlated with significantly lower frequency of external bleeding and reduced need for leech therapy, though overall survival did not differ by vein count.
Почему это важно для гирудотерапии
This retrospective review of 143 fingertip replantations (134 patients) evaluated whether the number of venous anastomoses (zero, one, or two or more) affected survival rates and the need for external bleeding or leech therapy. While survival rates did not differ significantly across groups, more venous anastomoses were associated with significantly less need for external bleeding and consequently leech therapy. For ASH's domain, this study is relevant because it identifies surgical factors that may reduce or eliminate the need for leech therapy in fingertip replantation. The main caveat is that leech therapy was not the primary endpoint; rather, it was a downstream consequence of venous congestion management decisions, so the study provides indirect evidence about when leech therapy may be avoided but does not evaluate its efficacy.
Цитирование
Multiple venous anastomoses decrease the need for intensive postoperative management in Tamai zone I replantations.
Ryu DH et al. · Archives of plastic surgery, 2017
Связанный клинический контекст
Узнайте, как это исследование связано с клинической практикой
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