Postoperative management after digit replantation and revascularization: a systematic review and proposal for a...

Postoperative management after digit replantation is considered critical, yet practices remain poorly standardized. A PRISMA-compliant systematic review (PROSPERO CRD420251070002) was performed to describe postoperative protocols after digit replantation/revascularization and to propose a pragmatic protocol and monitoring chart. MEDLINE, Embase, and the Cochrane Library were searched (initial search 13 July 2025; last search 1 February 2026). From 450 records, 53 studies were included, reporting 18,935 replanted digits, of which 13,903 survived (73.4%). Most studies were retrospective, and reporting of postoperative care was incomplete, precluding quantitative pooling. The greatest between-study variability concerned antithrombotic strategies (heparin used in 73% of reporting studies, with wide variation in dose, route, timing, and duration), antibiotic prophylaxis, and monitoring frequency and duration; warming/positioning, transfusion thresholds, leech therapy, and rehabilitation were also inconsistently reported. We provide a pragmatic, evidence-informed, resource-adaptable postoperative protocol and monitoring chart, derived from reporting patterns and mechanistic rationale rather than comparative data, to improve reproducibility and enable more comparable reporting in future studies. This framework is not a validated regimen. Survival was reported far more consistently than functional and patient-centered outcomes, a reporting gap that future studies should address. LEVEL OF EVIDENCE: IV.