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J Korean Med Sci. 2018 Feb 26;33(9):e72. doi: 10.3346/jkms.2018.33.e72.

The Concept of Door-to-Surgery Time in Distal Digital Replantation.

Author information

1
Department of Plastic and Reconstructive Surgery, Chonnam National University Medical School, Gwangju, Korea.
2
Department of Plastic and Reconstructive Surgery, Chonnam National University Medical School, Gwangju, Korea. psjhhwang@daum.net.

Abstract

BACKGROUND:

Digital replantation has become a well-established technique that has revolutionized hand surgery. One of the most important factors to a successful replantation is less than 12 hours of warm and 24 hours of cold ischemia time. The purpose of this article was to present a concept of door-to-surgery time and test the hypothesis that success in distal digital replantation is associated with this time.

METHODS:

Forty-five patients with 49 distal amputations were included in the study. Data regarding patient demographics, amputation characteristics, ischemia time, and surgical outcome were collected. Factors related to a successful replantation were analyzed. Fisher's exact test was used for statistical analysis.

RESULTS:

Type I, II, and III Yamano classification were noted in 11 (22.4%), 11 (22.4%), and 27 (55.1%) amputations. All the digits had arterial anastomoses while 19 (38.8%) digits were replanted without venous anastomosis. The mean door-to-surgery time was 229 minutes. The overall success rate was 77.6%. There were no differences in the survival rates between replantations with or without venous anastomosis. Patients with less than 180 minutes of door-to-surgery time had a significantly better survival rate compared to patients with greater time.

CONCLUSION:

The overall success rate was 77.6%. Patients with less than 180 minutes of door-to-surgery time had a significantly greater success rate (95.0%) compared to patients with longer door-to-surgery time (65.5%). Further effort must be made to achieve this goal in digital replantation.

KEYWORDS:

Digital Replantation; Door-to-Surgery Time; Ischemia Time

PMID:
29441741
PMCID:
PMC5811663
DOI:
10.3346/jkms.2018.33.e72
[Indexed for MEDLINE]
Free PMC Article

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