The Learning Curve in Digital Replant Surgery: 46 Prospectively Collected Cases From a Single Surgeon Over a 10-Year
Joshua W Hustedt1, N Ake Nystrom2, Lloyd Champagne3
1Orthopaedic Surgery, University of Arizona College of Medicine, Phoenix, USA.
Cureus
|September 4, 2024
Summary
Digital replantation success improved significantly with surgeon experience. Over 100 hours of microvascular surgery experience correlated with higher survival rates for digital replantation.
Area of Science:
- Microsurgery
- Reconstructive Surgery
- Hand Surgery
Background:
- Digital replantation is a complex microsurgical procedure.
- Success rates are influenced by surgeon expertise and experience.
Purpose of the Study:
- To investigate the impact of the surgical learning curve on microvascular digital replantation outcomes.
- To identify factors associated with successful digital replantation.
Main Methods:
- Review of a prospectively maintained surgical database (2002-2012) of 46 digital replantation cases.
- All cases performed by a single surgeon post-fellowship.
- Outcomes analyzed based on time since fellowship, operative experience, and injury type.
Main Results:
- Overall digital replantation success rate was 82.6% (38/46).
- Significant improvement in survival percentages observed over time (p=0.04).
- Microvascular operative experience strongly associated with success (p<0.001), with improved odds after 100 hours (OR 8.5). Crush and thumb injuries had poorer outcomes.
Conclusions:
- Digital replant survival shows marked improvement with experience.
- A significant increase in survival odds was noted after 100 hours of microvascular experience, achieved around 2 years for a high-volume surgeon.
- Evidence supports a steep learning curve in microvascular digital replantation surgery.
