Digital replantation and revascularization. Factors affecting viability, prognosis, and pattern of injury

As experience with digital replantation increases, preoperative factors affecting outcome are being identified. Injury type, injury cause, ischemia time, and zone of injury have previously been reported. In addition, this report analyzes the effect of injury pattern and surgical group upon outcome. This data implies a multi-factor effect on the viability of replanted/revascularized parts. The lack of thorough reporting of the factors may account for the variability seen in success rates of various centers. An injury-injury type-injury level-ischemia time classification scheme has been proposed to standardize the reporting and the discussing of amputation/devascularization injuries. In clear cut situations, injury pattern may simply reflect type of injury (e.g. avulsion); however, in those situations where the mechanism is unclear, injury patterns may provide prognostic variables valuable in predicting replant viability. Further, a multi-group, multi-surgeon service functioning within a hospital may have results comparable to those of a single surgeon or single group practice.