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Clinical Results of Minor Upper Extremity Replantation and Revascularisation Patients in Comparison to the Literature: A Clinical Study

Year 2015, Volume: 22 Issue: 4, 243 - 248, 14.12.2015

Abstract

Objectives: To evaluate the minor upper extremity replantation and revascularisation cases and to compare the clinical results with those in the literature.

Materials and Methods: Our study covers upper extremity trauma repair operations of 35 fingers of 30 patients who recieved treatment in our clinic betwen 2008 and 2011 date. The total number of amputated fingers that underwent replantation was 15 (of 15 patients) while 20 fingers of 15 patients underwent revascularisation operation for amputated fingers. We have conducted a retrospective study of the early period results of patients, who have been followed for an average of 17 months (6 months - 3.5 years).

Results: The survival rate for replantation cases was 93.3%; this rate was 80% for revascularised fingers. The survival rate for zone 2 injuries was 66.6%; the survival rate for zone 3 injuries was 92.3%. The survival rate for guillotine type injuries was 100% of the; this rate was 68.8% for   crush and avulsion type injuries. The evaluation of functional results based on Chen criterion and in terms of injury patterns has shown that 89.9%  of guillotine-type incision patients showed very good results while 33.3% of the crush and avulsion type injury patients returned with very good results as 44.4% of these patients showed moderate results. The statistical evaluation of the functional outcomes of the distal parts showed better improvemnet in guillotine-type injuries compared to crush and avulsion type injuries.

Conclusions: Minor replantation and revascularisation operations are difficult and require various equipments. Our results are compatible with the literature in terms of the large replantation series.

Keywords: Replantation; Revascularization; Total-Subtotal Amputation.

References

  • Gülgönen A. Mikrocerrahi ve üst ekstremite replantasyonları. Üçüncü el cerrahisi ve rekonstrüksiyonu kongre kitabı. 1. Baskı, Ankara:T.H.K Basımevi; 1994. p. 44-5.
  • Coşkunol E, Özdemir O, Kaplan İ, Çallı İ. Parmak ve el düzeyinde replantasyon yapılan 33 olgunun klinik analizi ve fonksiyonel sonuçları. Üçüncü elcerrahisi ve rekonstrüksyonu kongre kitabı. 1. Baskı, Ankara: T.H.K. Basımevi; 1994. p. 59-61.
  • Vaksvik T, Hetland K, Rokkum M, Holm I. Cold hypersensitivity 6 to 10 years after replantation or revascularisation of fingers: consequences for work and leisure activities. J Hand Surg Eur 2009;34:12-7.
  • Goldner RD, Urbaniak JR. Replantation. In: Gren DP, Eds. Operative Hand Surgery. 4’th editon. Volume 1, New York: Churchill Livigstone; 1999. p. 1139-55.
  • Aladin A; Davis TR. Dorsal fracture–dislocation of the proximal interphalangeal joint: a comparative study of percutaneous Kirschner wire fixation versus open reduction and internal fixation. J Hand Surg Eur 2005;30:120–8.
  • KleinWeigel P, Pavelka M, Dabernig J, Rein P, Kronenberg F, Fraedrich G, et al. Macro- and microcirculatory assessment of cold sensitivity after traumatic finger amputation and microsurgical replantation. Arch Orthop Trauma Surg 2007;127:355–60.
  • Morrison WA, O’brien BM, Macleod AM. Evaluation of digital replantation-a reviev of 100 cases. The Orthopaedic Clinics Of North America 1977;8:295-308.
  • Goldner RD. Postoperative management hand clinics. Microvascular Surgery 1985;2:205-15.
  • Urbaniak J R. Replantation. Operative Orthopaedics, 2nd Ed. Volume 1, Philadelphia: JB Lippincott Company; 1993. p. 1047-63.
  • Biemer D. Vein in microvascular surgery. British Plastic Surgery 1977;30:197-9.
  • Weiland A.J, Alferdo UR, Kleinert H E, Kutz J, Atasoy E, Lister G. Replantation of digits and hands: analysis of surgical techniques and functional results in 71 patients with 86 replantations. Journal of Hand Surgery 1977;2:1.
  • Schlenker JD, Kleinert HE, Tsai TM. Methods and results of replantation following traumatic amputation of the thumb in 64 patients. Journal of Hand Surgery 1980;5:63-70
  • Hamilton RB, O’Brien BM, Morrison A, Mcleod AM. Survival factors in replantation and revascularization of the amputated thumbs- ten years experience. Scand Journal of Plastic And Reconstructive Surgery 1984;18:163-73.
  • Troum S, Floyd WE. Upper extremity replantation at regional medical center. a six-year review. American Surgery 1995;61:836-9.
  • Scott FA. Complications following replantaton and revascularization. Complications in Hand Surgery, Saunders Company 1986;204-14.
  • Blomgren I, Blomqvist G. Hand function after replantation or revascularization of upper extremity injuries. Scand Journal of Plastic And Reconstructive Surgery Hand Surgery 1988;22:93-101.
  • Millesi H. Interfasciculer nevre grafting. The Orthopaedic Clinics of North America 1981;12:287-301.
  • Synder CC. Epineurial repair. The Orthopaedic Clinics of North America 1981;12:267-76.
  • Akşamoğlu MH. Median ve unlar sinir kesilerinde primer tamir ve geç sonuçlarımız. Uzmanlık Tezi, Çukurova Üniversitesi, Adana/Türkiye 1998.
  • Reichel AC, Croll HG, Puckett OL. Comparison of irrigation solutions for microanastomoses. Journal Of Hand Surgery 1988;13:33-6.

Journal of Turgut Ozal Medical Center

Year 2015, Volume: 22 Issue: 4, 243 - 248, 14.12.2015

Abstract

Amaç: Üst ekstremite minör replantasyon ve revaskülarizasyon uygulanan hastaların klinik sonuçlarının değerlendirilip literatür ile karşılaştırılması amaçlandı. Gereç ve Yöntem: Kliniğimizde 2008–2011 tarihleri arasında üst ekstremitelerin’de travma sonucu total veya subtotal amputasyon oluşan 30 hastanın 35 parmağı ameliyat edildi. Total ampute 15 hastanın 15 parmağına replantasyon, ve subtotal ampute 15 hastanın 20 parmağına revaskülarizasyon yapıldı. Tedavi edilen tüm hastaların erken dönem sonuçları ile ortalama 17 ay (6 ay – 3.5 yıl) izlenen 28 hastanın 30 parmağı retrospektif olarak incelendi. Bulgular: Erken dönem sonuçlar incelendiğinde, yaşama oranları; replantasyon yapılan parmaklarda %93,3, revaskülarizasyon yapılan parmaklarda %80 olarak saptandı. Zon iki seviyesindeki yaralanmalarda yaşama oranı %66,6 iken zon 3 seviyesindeki yaralanmalarda %92,3 idi. Giyotin tipi yaralanmalarda ise %100 yaşama oranı mevcut iken, ezilme- avülsiyon tipi yaralanmalarda %68,8 olarak bulundu. Yaralanma şekillerine göre fonksiyonel sonuçlar Chen kriterlerine göre değerlendirildiğinde, giyotin tipi kesi ile yaralanan olguların %89.9’unda çok iyiiyi, ezilme ve avulsiyon tipi kesi ile yaralanan olguların %33,3‘ünde çok iyi-iyi, %44.4’ünde orta sonuç bulundu. Yapılan istatiksel değerlendirmede giyotin tipi kesilerle yaralanan olguların tedavi sonrası distal parçalarda yaşama oranları ve fonksiyonel sonuçlarının ezilme ve avulsiyon tipi yaralanmalara göre anlamlı olarak daha iyi olduğu bulundu. Sonuç: Minör replantasyon ve revaskülarizasyon uygulamaları teknik olarak zor ve donanımlı ekip gerektirmektedir. Replantasyon sonuçlarımız literatürle uyumlu olup daha geniş serili çalışmaların gerektiği kaçınılmazdır

References

  • Gülgönen A. Mikrocerrahi ve üst ekstremite replantasyonları. Üçüncü el cerrahisi ve rekonstrüksiyonu kongre kitabı. 1. Baskı, Ankara:T.H.K Basımevi; 1994. p. 44-5.
  • Coşkunol E, Özdemir O, Kaplan İ, Çallı İ. Parmak ve el düzeyinde replantasyon yapılan 33 olgunun klinik analizi ve fonksiyonel sonuçları. Üçüncü elcerrahisi ve rekonstrüksyonu kongre kitabı. 1. Baskı, Ankara: T.H.K. Basımevi; 1994. p. 59-61.
  • Vaksvik T, Hetland K, Rokkum M, Holm I. Cold hypersensitivity 6 to 10 years after replantation or revascularisation of fingers: consequences for work and leisure activities. J Hand Surg Eur 2009;34:12-7.
  • Goldner RD, Urbaniak JR. Replantation. In: Gren DP, Eds. Operative Hand Surgery. 4’th editon. Volume 1, New York: Churchill Livigstone; 1999. p. 1139-55.
  • Aladin A; Davis TR. Dorsal fracture–dislocation of the proximal interphalangeal joint: a comparative study of percutaneous Kirschner wire fixation versus open reduction and internal fixation. J Hand Surg Eur 2005;30:120–8.
  • KleinWeigel P, Pavelka M, Dabernig J, Rein P, Kronenberg F, Fraedrich G, et al. Macro- and microcirculatory assessment of cold sensitivity after traumatic finger amputation and microsurgical replantation. Arch Orthop Trauma Surg 2007;127:355–60.
  • Morrison WA, O’brien BM, Macleod AM. Evaluation of digital replantation-a reviev of 100 cases. The Orthopaedic Clinics Of North America 1977;8:295-308.
  • Goldner RD. Postoperative management hand clinics. Microvascular Surgery 1985;2:205-15.
  • Urbaniak J R. Replantation. Operative Orthopaedics, 2nd Ed. Volume 1, Philadelphia: JB Lippincott Company; 1993. p. 1047-63.
  • Biemer D. Vein in microvascular surgery. British Plastic Surgery 1977;30:197-9.
  • Weiland A.J, Alferdo UR, Kleinert H E, Kutz J, Atasoy E, Lister G. Replantation of digits and hands: analysis of surgical techniques and functional results in 71 patients with 86 replantations. Journal of Hand Surgery 1977;2:1.
  • Schlenker JD, Kleinert HE, Tsai TM. Methods and results of replantation following traumatic amputation of the thumb in 64 patients. Journal of Hand Surgery 1980;5:63-70
  • Hamilton RB, O’Brien BM, Morrison A, Mcleod AM. Survival factors in replantation and revascularization of the amputated thumbs- ten years experience. Scand Journal of Plastic And Reconstructive Surgery 1984;18:163-73.
  • Troum S, Floyd WE. Upper extremity replantation at regional medical center. a six-year review. American Surgery 1995;61:836-9.
  • Scott FA. Complications following replantaton and revascularization. Complications in Hand Surgery, Saunders Company 1986;204-14.
  • Blomgren I, Blomqvist G. Hand function after replantation or revascularization of upper extremity injuries. Scand Journal of Plastic And Reconstructive Surgery Hand Surgery 1988;22:93-101.
  • Millesi H. Interfasciculer nevre grafting. The Orthopaedic Clinics of North America 1981;12:287-301.
  • Synder CC. Epineurial repair. The Orthopaedic Clinics of North America 1981;12:267-76.
  • Akşamoğlu MH. Median ve unlar sinir kesilerinde primer tamir ve geç sonuçlarımız. Uzmanlık Tezi, Çukurova Üniversitesi, Adana/Türkiye 1998.
  • Reichel AC, Croll HG, Puckett OL. Comparison of irrigation solutions for microanastomoses. Journal Of Hand Surgery 1988;13:33-6.
There are 20 citations in total.

Details

Primary Language Tr
Journal Section Articles
Authors

Seyfullah Doğan This is me

Kadir Ertem This is me

Mustafa Karakaplan This is me

Reşit Sevimli

Bünyamin Arı This is me

Özgür Yılmaz This is me

Publication Date December 14, 2015
Published in Issue Year 2015 Volume: 22 Issue: 4

Cite

APA Doğan, S., Ertem, K., Karakaplan, M., Sevimli, R., et al. (2015). Clinical Results of Minor Upper Extremity Replantation and Revascularisation Patients in Comparison to the Literature: A Clinical Study. Journal of Turgut Ozal Medical Center, 22(4), 243-248.
AMA Doğan S, Ertem K, Karakaplan M, Sevimli R, Arı B, Yılmaz Ö. Clinical Results of Minor Upper Extremity Replantation and Revascularisation Patients in Comparison to the Literature: A Clinical Study. J Turgut Ozal Med Cent. December 2015;22(4):243-248.
Chicago Doğan, Seyfullah, Kadir Ertem, Mustafa Karakaplan, Reşit Sevimli, Bünyamin Arı, and Özgür Yılmaz. “Clinical Results of Minor Upper Extremity Replantation and Revascularisation Patients in Comparison to the Literature: A Clinical Study”. Journal of Turgut Ozal Medical Center 22, no. 4 (December 2015): 243-48.
EndNote Doğan S, Ertem K, Karakaplan M, Sevimli R, Arı B, Yılmaz Ö (December 1, 2015) Clinical Results of Minor Upper Extremity Replantation and Revascularisation Patients in Comparison to the Literature: A Clinical Study. Journal of Turgut Ozal Medical Center 22 4 243–248.
IEEE S. Doğan, K. Ertem, M. Karakaplan, R. Sevimli, B. Arı, and Ö. Yılmaz, “Clinical Results of Minor Upper Extremity Replantation and Revascularisation Patients in Comparison to the Literature: A Clinical Study”, J Turgut Ozal Med Cent, vol. 22, no. 4, pp. 243–248, 2015.
ISNAD Doğan, Seyfullah et al. “Clinical Results of Minor Upper Extremity Replantation and Revascularisation Patients in Comparison to the Literature: A Clinical Study”. Journal of Turgut Ozal Medical Center 22/4 (December 2015), 243-248.
JAMA Doğan S, Ertem K, Karakaplan M, Sevimli R, Arı B, Yılmaz Ö. Clinical Results of Minor Upper Extremity Replantation and Revascularisation Patients in Comparison to the Literature: A Clinical Study. J Turgut Ozal Med Cent. 2015;22:243–248.
MLA Doğan, Seyfullah et al. “Clinical Results of Minor Upper Extremity Replantation and Revascularisation Patients in Comparison to the Literature: A Clinical Study”. Journal of Turgut Ozal Medical Center, vol. 22, no. 4, 2015, pp. 243-8.
Vancouver Doğan S, Ertem K, Karakaplan M, Sevimli R, Arı B, Yılmaz Ö. Clinical Results of Minor Upper Extremity Replantation and Revascularisation Patients in Comparison to the Literature: A Clinical Study. J Turgut Ozal Med Cent. 2015;22(4):243-8.