Predictors of Digit Survival following Replantation: Quantitative Review and Meta-Analysis.
Ashkaun Shaterian, MD; Ramin Rajaii, MS; Melissa Kanack, MD; Gregory R.D. Evans, MD, FACS; Amber Leis, MD
University of California Irvine, Orange, CA
Introduction: Microsurgical replantation following digital amputation has variable success rates. Sociodemographic factors and surgery-related variables have been shown to influence survival rates, however, few studies have evaluated this data systematically across a combined data set. Therefore, the objective of this study was to analyze the current literature to identify the predictors of replant survival.
Materials/Methods: A literature review was performed using the PubMed/MEDLINE database focused on complete digit amputation/replantation studies. Studies were evaluated for patient and surgery-related variables and their respective effects on survival. Statistical analysis was conducted to identify predictors of survival and derive pooled estimates from the combined data set.
Results: Thirty-two studies representing over 6,000 digit amputation/replantation cases met inclusion/exclusion criteria. Statistical analysis revealed the number of venous anastomosis (0 vs. 1 vs. 2), the number of arterial anastomosis (0 vs. 1 vs 2), and the mechanism of injury (sharp cut vs. blunt cut vs. avulsion vs. crush) to influence replant survival (p-value <0.05). We failed to find a significant association between survival and the following variables: age, gender, zone of injury, digit number, tobacco use, ischemia time, method of preservation, use of vein graft.
Conclusions: Patient- and surgery-related variables affect digit survival following replantation. The etiology of injury can help risk-stratify patients and assist in an informed decision making process, whereas surgery-related factors can guide surgeon practice to improve clinical outcomes following replantation.
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