Abstract:
BACKGROUND: Replantation of a single digit at the distal phalanx level is not routinely performed since it is technically challenging with questionable cost-effectiveness. The purpose of this study was to analyze international microsurgeons' clinical decisions when faced with this common scenario. METHODS: A survey of a right-middle finger distal phalanx transverse complete amputation case was conducted via online and paper questionnaires. Microsurgeons around the world were invited to provide their treatment recommendations. In total, 383 microsurgeons replied, and their responses were stratified and analyzed by geographical areas, specialties, microsurgery fellowship training, and clinical experiences. RESULTS: Among 383 microsurgeons, 170 (44.3%) chose replantation as their preferred management option, 137 (35.8%) chose revision amputation, 62 (16.2%) chose local flap coverage, 8 (2.1%) chose composite graft, and 6 (1.6%) favored other choices as their reconstruction method for the case study. Microsurgeons from the Asia-Pacific, Middle East/South Asia, and Central/South America regions tend to perform replantation (70.7, 68.8, and 67.4%, respectively) whereas surgeons from North America and Europe showed a lower preference toward replantation (20.5 and 26.8%, respectively p < 0.001). Having completed a microsurgery fellowship increased the attempt rate of replantation by 15.3% (p = 0.004). Clinical experience and the surgeons' specialties did not show statistical significance in clinical decision making. CONCLUSION: From the present study, the geographic preferences and microsurgery fellowship experience influence the method of reconstruction for distal phalanx amputation. Multiple factors are taken into consideration in selecting the most suitable reconstructive method for each case scenario. In addition to the technical challenges of the proposed surgery, the cost of the procedure and the type of facility needed are important variables in the decision making process.
journal_name
J Reconstr Microsurgjournal_title
Journal of reconstructive microsurgeryauthors
Kwon SH,Lao WW,Hsu AT,Lee CH,Hsu CC,Huang JJ,Qiu SS,Tilkorn D,Tang ET,Lu JC,Chang TNdoi
10.1055/s-0039-1701013subject
Has Abstractpub_date
2020-05-01 00:00:00pages
301-310issue
4eissn
0743-684Xissn
1098-8947journal_volume
36pub_type
杂志文章abstract::Multiple level amputation has been described as a contraindication to replantation. This is a case report of a patient with a double level amputation through the palm and forearm that was successfully replanted. Because of the need for multiple stages of reconstructive surgery, it was not clear until the end result th...
journal_title:Journal of reconstructive microsurgery
pub_type: 杂志文章
doi:10.1055/s-2007-1007016
更新日期:1986-04-01 00:00:00
abstract:BACKGROUND: Osteoradionecrosis (ORN) is one of the most severe complications of free fibula reconstruction after radiotherapy. The gold standard treatment of osteomyelitis involves extensive debridement, antibiotics, and sufficiently vascularized muscle flap coverage for better circulation. Therefore, we hypothesized t...
journal_title:Journal of reconstructive microsurgery
pub_type: 杂志文章
doi:10.1055/s-0040-1722647
更新日期:2021-01-31 00:00:00
abstract:BACKGROUND: Face transplantation is a demanding operation requiring complex planning and expert technical performance. While the documentation of successes of the first transplants is impressive, there are lacunae in reporting of institutional protocols for other critical operation components, namely, immunosuppression...
journal_title:Journal of reconstructive microsurgery
pub_type: 杂志文章
doi:10.1055/s-0039-1691787
更新日期:2019-11-01 00:00:00
abstract::As reimbursement for free-tissue transfer decreases, the authors find an increase in the number of free flaps performed at their county facility. Over 60 percent of the free flaps performed during the past 10 years were completed within the last 4 years. This influx of patients prompted a review of their experience wi...
journal_title:Journal of reconstructive microsurgery
pub_type: 杂志文章
doi:10.1055/s-2001-16357
更新日期:2001-08-01 00:00:00
abstract::The rat model is commonly utilized in peripheral nerve research. Due to the short length of the rat limb and the animal's inherent neuroregenerative capacity, the timing of assessment of nerve regeneration is critical, and significant differences between groups can be lost if assessment is done too late. Additionally,...
journal_title:Journal of reconstructive microsurgery
pub_type: 杂志文章
doi:10.1055/s-2001-14350
更新日期:2001-04-01 00:00:00
abstract::The use of a free compound rib-latissimus dorsi osteomusculocutaneous flap is described, for reconstruction of the tibia and soft tissue of the leg. The entire flap depends on the thoracodorsal artery for its blood supply. Dye injection studies of the artery demonstrated continuity between it and the intercostal arter...
journal_title:Journal of reconstructive microsurgery
pub_type: 杂志文章
doi:10.1055/s-2007-1007032
更新日期:1986-10-01 00:00:00
abstract::Sixteen arterialized venous flaps, free flaps that have arterial blood only flowing through the vein of the flap, were applied to reconstruct skin defects of the big toe resulting from wrap-around flap transfers. There were seven complete successes, six partial successes, and three complete failures. The clinical cour...
journal_title:Journal of reconstructive microsurgery
pub_type: 杂志文章
doi:10.1055/s-2007-1006756
更新日期:1991-01-01 00:00:00
abstract:BACKGROUND: Various reports suggest the augmentation of venous drainage through performing two venous anastomoses as a means of reducing the rate of thrombosis in free flap surgery. However, some suggest dual venous drainage may actually reduce venous blood flow velocity causing a potential risk for thrombosis. METHOD...
journal_title:Journal of reconstructive microsurgery
pub_type: 杂志文章,meta分析,评审
doi:10.1055/s-0034-1372368
更新日期:2014-07-01 00:00:00
abstract::Microvascular clamps have several potential shortcomings, including the risk of vessel injury. LeGoo, a novel reverse thermosensitive polymer (Pluromed Inc., Woburn, MA), is investigated as a substitute to vascular clamping in a microsurgical model and the technical details are described. Femoral vessels of Sprague Da...
journal_title:Journal of reconstructive microsurgery
pub_type: 杂志文章
doi:10.1055/s-0028-1104556
更新日期:2009-01-01 00:00:00
abstract::Injury to the dorsal sensory nerve of the penis following penile prosthesis insertion is extremely rare. The authors report on a patient with insensitivity involving the right penile shaft and glans secondary to entrapment and fibrosis of the dorsal cutaneous nerve of the penis, following penile prosthesis insertion. ...
journal_title:Journal of reconstructive microsurgery
pub_type: 杂志文章
doi:10.1055/s-2007-1006898
更新日期:1998-01-01 00:00:00
abstract::The ultrastructure of the early regenerative response in an end-to-side neurorrhaphy rat model was studied using transmission electron microscopy. The ipsilateral saphenous nerve was grafted to the sciatic nerve under the following conditions: Group 1, the epineurium and perineurium of the sciatic nerve remained intac...
journal_title:Journal of reconstructive microsurgery
pub_type: 杂志文章
doi:10.1055/s-2000-7339
更新日期:2000-05-01 00:00:00
abstract:BACKGROUND: Limb-threatening lower extremity traumatic injuries can be devastating events with a multifaceted impact on patients. Therefore, evaluating patient-reported outcomes (PROs) in addition to traditional surgical outcomes is important. However, currently available instruments are limited as they were not develo...
journal_title:Journal of reconstructive microsurgery
pub_type: 杂志文章
doi:10.1055/s-0040-1713669
更新日期:2020-11-01 00:00:00
abstract::Ischemia/reperfusion (I/R) injury is one of the factors determining tissue survival in replantation and transplantation surgery. However, more than 20 methods have been used to evaluate I/R injury in muscle. The aim of this study was to examine I/R injury in muscle tissue in a model of composite tissue allotransplanta...
journal_title:Journal of reconstructive microsurgery
pub_type: 杂志文章
doi:10.1055/s-2004-823113
更新日期:2004-04-01 00:00:00
abstract::There is increased clinical use of computer-assisted design (CAD) and computer-assisted modeling (CAM) for osseous flap reconstruction, particularly in the head and neck region. Limited information exists about methods to optimize the application of this new technology and for cases in which it may be advantageous ove...
journal_title:Journal of reconstructive microsurgery
pub_type: 杂志文章
doi:10.1055/s-0033-1358789
更新日期:2014-06-01 00:00:00
abstract::Blood flow distribution in conventional and vascularized canine nerve grafts was analyzed. Between 4 and 6 days after operation, blood flow at both the fascicular (endoneural) and the nerve-sheath (epineural) levels was significantly greater in the nonvascularized nerve grafts than in their vascularized counterparts (...
journal_title:Journal of reconstructive microsurgery
pub_type: 杂志文章
doi:10.1055/s-2007-1007044
更新日期:1985-10-01 00:00:00
abstract:BACKGROUND: Unfractionated heparin has anticoagulant properties by catalyzing antithrombin III, which inactivates coagulation enzymes. Used in microsurgery, it would prevent the occurrence of thrombosis during microsurgical anastomoses. The objective of this study was to evaluate the role of intraoperative irrigation o...
journal_title:Journal of reconstructive microsurgery
pub_type: 杂志文章
doi:10.1055/s-0039-1694723
更新日期:2020-01-01 00:00:00
abstract::Although often a life-saving therapeutic maneuver, there is minimal data available that details the effects of intraoperative packed red blood cell transfusion (IOT) after microvascular free tissue transfer. The National Surgical Quality Improvement Program database was queried to identify all patients who underwent m...
journal_title:Journal of reconstructive microsurgery
pub_type: 杂志文章,多中心研究
doi:10.1055/s-0033-1357275
更新日期:2014-02-01 00:00:00
abstract::Systematic scanning electron microscopic observations of the healing mechanism in the endothelium of rat carotid arteries were carried out at the site of anastomosis. The site of needle holes and stitches are the main locations for thrombocyte adhesion and aggregation in normal vascular anastomosis. The repair process...
journal_title:Journal of reconstructive microsurgery
pub_type: 杂志文章
doi:
更新日期:1989-10-01 00:00:00
abstract::Bypass grafting around a neuroma-in-continuity entails coapting a nerve graft above and below the injured segment using two sequential end-to-side repairs. The proximal repair is analogous to what has been classically described as an end-to-side repair; the axons from the intact nerve sprout into the end of a recipien...
journal_title:Journal of reconstructive microsurgery
pub_type: 杂志文章
doi:10.1055/s-0028-1088230
更新日期:2008-10-01 00:00:00
abstract::The authors present 20 microvascular flaps based on arteriovenous perfusion, harvested from the distal anterior forearm, and configured in three different designs. Indications were small palmar, dorsal, and commissural defects, when other conventional procedures were not available; problematic cases of open reduction ...
journal_title:Journal of reconstructive microsurgery
pub_type: 杂志文章
doi:10.1055/s-2007-1000235
更新日期:1997-05-01 00:00:00
abstract::The goal of craniofacial reconstruction is not only life-saving but also facial aesthetics. From this viewpoint the authors evaluated the facial symmetry of patients after craniofacial reconstruction. The subjects were seven patients reconstructed after craniofacial resections. Their CT or MR images were evaluated jus...
journal_title:Journal of reconstructive microsurgery
pub_type: 杂志文章
doi:10.1055/s-2006-951313
更新日期:2006-10-01 00:00:00
abstract::The anterolateral thigh (ALT) flap is now considered a workhorse for head and neck reconstruction in many centers. However, designing and raising the ALT flap has been traditionally recognized as being difficult, tedious, and technically demanding due to its variation in perforator anatomy. Designing the ALT flap on d...
journal_title:Journal of reconstructive microsurgery
pub_type: 杂志文章
doi:10.1055/s-0029-1234023
更新日期:2010-01-01 00:00:00
abstract::The spinal cord cannot heal after severance because the central nervous system is "non-permissive" to the advancement of axons that regrow from presynaptic motoneurons. With the aim of overcoming paraplegia, the author has carried out extensive experimental research since 1980, first in rats and subsequently in monkey...
journal_title:Journal of reconstructive microsurgery
pub_type: 杂志文章
doi:10.1055/s-2001-18873
更新日期:2001-11-01 00:00:00
abstract::The authors report the application of the flow-through concept to a distally-pedicled radial forearm flap for simultaneous thumb revascularization and soft-tissue coverage. A distally-pedicled radial forearm flap was used to cover a skin defect at the base of thumb and thenar area. The flap artery (reversed radial art...
journal_title:Journal of reconstructive microsurgery
pub_type: 杂志文章
doi:10.1055/s-2007-1000206
更新日期:1998-10-01 00:00:00
abstract::The authors' experience indicates that good functional results are achievable in cases with wide resection of the knee extensor mechanism. They report a low-grade myxoid fibrosarcoma patient in whom a one-stage functional reconstruction was carried out by transfer of a free latissimus dorsi flap without secondary surg...
journal_title:Journal of reconstructive microsurgery
pub_type: 杂志文章
doi:10.1055/s-2005-871749
更新日期:2005-05-01 00:00:00
abstract::A retrospective analysis of 100 consecutive patients undergoing free fibula harvest at the Mayo Clinic is presented. Every patient was analyzed by reviewing postoperative physical examination data. All patients were evaluated and followed in the early postoperative course by the physical medicine and rehabilitation se...
journal_title:Journal of reconstructive microsurgery
pub_type: 杂志文章
doi:10.1055/s-2000-7544
更新日期:2000-02-01 00:00:00
abstract:BACKGROUND: In 2017, our institution initiated a cadaver laboratory-based course dedicated to teaching reconstructive microsurgery indications, preoperative planning, and flap dissection. The goals of this study are to describe the demographics and experience of participants/instructors and to evaluate the learning obj...
journal_title:Journal of reconstructive microsurgery
pub_type: 杂志文章
doi:10.1055/s-0040-1716320
更新日期:2021-02-01 00:00:00
abstract::This article introduces a free flap based on the medial femoral main cutaneous artery. Flap transfer was carried out in two cases with complete postoperative success. An anatomical description of the midportion of the medial femoral region, based on magnification and binocular dissection microscope studies is provided...
journal_title:Journal of reconstructive microsurgery
pub_type: 杂志文章
doi:10.1055/s-2007-1007090
更新日期:1985-07-01 00:00:00
abstract::The reconstruction of the flexor tendon in zones I and II of a ring finger in a single stage, using a free vascularized tendon graft, is reported in a single clinical case. The flexor digitorum superficialis (FDS) tendon of the same finger was freely transferred based on a vascular branch off the ulnar vessels. The ul...
journal_title:Journal of reconstructive microsurgery
pub_type: 杂志文章
doi:10.1055/s-2006-931905
更新日期:2006-01-01 00:00:00
abstract::This study investigated the intact nerve bridge technique for overcoming peripheral nerve gap defects in a rabbit model. To create the intact nerve bridge, a 1-cm segment of the peroneal nerve is resected leaving a gap defect. The proximal and distal peroneal nerve stumps are sutured 1 cm apart, in an end-to-side fash...
journal_title:Journal of reconstructive microsurgery
pub_type: 杂志文章
doi:10.1055/s-2005-869827
更新日期:2005-04-01 00:00:00