Abstract
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 these data systematically across
a combined dataset. Therefore, the objective of this study was to analyze the current
literature to identify the predictors of replant survival.
Materials and 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 dataset.
Results Thirty-two studies representing more than 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 versus blunt cut versus avulsion versus crush)
to influence replant survival (p < 0.05). The authors failed to find a significant association between survival and
the following variables: age, sex, zone of injury, digit number, tobacco use, ischemia
time, method of preservation, and use of vein graft.
Conclusion 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.
Keywords
amputation - digit survival - microsurgical replantation
