A meta-analysis study of replantation and revascularization of finger and hand indication and contraindication in relation to success of replantation

Background:Replantation and revascularization of amputated digits are complex surgical procedures influenced by various factors, including the mechanism of injury, the specific digit involved, and the duration of ischemia. Understanding these factors is crucial for improving the outcomes of replantation surgeries. This meta-analysis aimed to evaluate the success of replantation in relation to these key factors to provide evidence-based guidance for clinical decision-making.Methodology: A systematic review and meta-analysis were conducted according to the PRISMA and MOOSE guidelines. Studies published between 2018 and 2023 that focused on replantation of fingers and hands were included. Data were extracted on the mechanism of injury (clean cut, crush, and avulsion), the specific digit involved (thumb vs. other digits), and ischemia time (<6 hours vs. >6 hours). Results:The meta-analysis revealed that clean-cut injuries were associated with the highest success rates in replantation, with a statistically significant pooled OR favoring clean-cut injuries over other types. Crush injuries showed variable outcomes, with moderate success rates depending on the extent of tissue damage. Avulsion injuries presented the greatest challenge, with significantly lower and more variable success rates. Replantation of non-thumb digits had a higher likelihood of success compared to thumb replantation. Conclusion: The success of replantation is significantly influenced by the mechanism of injury and the specific digit involved, with clean-cut injuries and non-thumb digits showing the best outcomes. While ischemia time remains an important consideration, it should not be the sole determinant in replantation decisions.