Replantation Of Upper Extremity Outcomes Following Traumatic Injuries: A Study On The National Trauma Databank
Charalampos Siotos, Amir Dorafshar, MBBS.
Rush University Medical Center, Chicago, IL, USA.
PURPOSE: Upper extremity trauma leading to amputation continue to represent a common injury faced by plastic surgeons. Depending on the level of injury, the experience of the surgeon, and the resources available, replantation may be attempted. We sought to evaluate outcomes of replantation in a national level.
METHODS: We obtained appropriate approval and we assessed the records of the National Trauma Databank in order to identify patients who underwent upper extremity (thumb, other fingers, hand and forearm, or upper arm) replantation from 2008 to 2016. Information of interest, including demographics, characteristics of the injury, complications and time to surgery were extracted. Multivariable logistic regression analysis was performed to evaluate risk factors leading to increased complications and median regression was completed to assess potential factors leading to delay of surgery.
RESULTS: We identified 2,083 patients who underwent non-thumb finger (54.5%), thumb (31.4%), hand and forearm (10.6%), or upper arm (3.5%) replantation. Patients had no statistically significant differences at baseline. Replantation failure was recorded in 20 (0.96%) patients. Our analysis showed that patient presented to small centers of less than 400 beds (OR 3.61, 95% CI 1.46-8.82) and obese patients (OR 4.82, 95% CI 1.21-19.29) had significantly higher rates of failure. Median time to surgery was 2.97 hours. Patients younger than 40 years of age, of Caucasian race, and patients with thumb or hand/forearm injury had statistically significantly shorter interval times, while obese patients had higher. Median time to surgery was not an independent predictors of replantation failure rates (OR 1.01, 95% CI 0.99-1.02).
CONCLUSION: On selected group of patients, replantation success rates are high. Selected patients, including obese patients and those presenting to small trauma centers may have worse outcomes. Time to surgery can also be affected by specific factors, but delays do not seem to be associated with worse outcomes.
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