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Safety and Suitability of Finger Replantations as a Residency Training Procedure: A Retrospective Cohort Study With Analysis of the Initial Postoperative Outcomes

Kotsougiani, Dimitra MD; Ringwald, Felicitas; Hundepool, Caroline A. MSc; Neubrech, Florian MD; Kremer, Thomas MD; Bickert, Berthold MD; Kneser, Ulrich MD; Hirche, Christoph MD

doi: 10.1097/SAP.0000000000000945
Microsurgery

Abstract: Finger replantations demand technical excellence in microsurgery and hand trauma care. The objective of this study was to determine whether finger replantations constitute an appropriate and safe procedure for residency training. Additionally, the prognostic risk factors for the need to take a replanted finger back to the operation room and replant failure were analyzed.

All patients who underwent finger replantation after complete amputation between 2007 and 2015 were included in a retrospective comparative study. These patients were either treated by an attending plastic surgeon (cohort 1) or by a postgraduate year 5 or 6 resident under supervision (cohort 2). Logistic regression analysis was used to identify the prognostic risk factors for emergent take backs and replant failures.

A total of 109 completely amputated fingers were replanted in 89 patients. Fifty-seven digits were replanted in cohort 1, and 52 digits were replanted in cohort 2. Patient demographic data revealed an equal distribution between the two cohorts with an overall finger-replantation success rate of 67.0%. The prognostic risk factors related to increased take back and replant failure rates were fewer than two venous anastomoses (take back odds ratio [AOR], 0.27; confidence interval (CI), 0.12–0.63; and replant failure AOR, 0.21; 95% CI, 0.08–0.55) and intraoperative noticeable problems regarding the vascular anastomoses (take back AOR, 2.26; 95% CI, 0.96–5.33 and replant failure AOR, 2.45; 95% CI, 1.00–6.00). The type of surgeon did not exhibit an influence on the risk of take back (OR, 1.14; 95% CI, 0.53–2.41) or replant failure (OR, 1.03; 95% CI, 0.46–2.30). Similarly, after adjusting for all risk factors, the risks for take backs (AOR, 1.04; 95% CI, 0.46–2.36) and replant failures (AOR, 0.91; 95% CI, 0.38–2.19) did not differ between the 2 cohorts.

Finger replantations can be applied as a safe procedure in residency training under standardized conditions and do not negatively affect quality of care. Technical proficiency in microsurgery and elective and trauma hand care as well as supervision by an experienced plastic or hand surgeon are mandatory. Regardless of the surgeons' experience, fewer than 2 venous anastomoses and the presence of intraoperative vascular anomalies represent significant prognostic risk factors for postoperative complications.

From the Department of Hand, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center Ludwigshafen, Hand and Plastic Surgery, University of Heidelberg, Heidelberg, Germany.

Received May 23, 2016, and accepted for publication, after revision September 21, 2016.

Reprints: Dimitra Kotsougiani, MD, Department of Hand, Plastic, and Reconstructive Surgery, BG Trauma Center Ludwigshafen, Hand and Plastic Surgery, University of Heidelberg, Heidelberg, Germany, Ludwig Guttmann Str. 13, 67071 Ludwigshafen, Germany. E-mail: dkotsougiani@googlemail.com.

Meetings at which the paper has been presented: Excerpts from this study have been orally presented at the 46th Conference of the German Society of Plastic Reconstructive and Aesthetic Surgery in Berlin, Germany, 3rd October 2015.

Conflicts of interest and sources of funding: none declared.

The study was performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments. Written Ethical committee approval (Mainz, Germany) was obtained that no further ethical consultation was needed because the study protocol included retrospective, epidemiologic evaluation of anonymized and routine patients' data, procedural and outcome parameters (Hospital State law Article 36 and 37).

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