title: A retrospective review of troubled replantations.
abstract: BACKGROUND
  Replantation surgery is an established treatment for amputated digits, and published literature report a high success rate. However, a proportion of replantations do encounter postoperative problems with vascularity, but the incidence is unknown. Although there are studies that look at the factors affecting the success of replantations and the management of postoperative replantations, there is little literature available on this transitional period. We introduce the term "troubled replantation" to describe the replantation that manifests any form of vascular insufficiency after replantation surgery. Our study focuses on reviewing our centre's experience with the management and outcomes of troubled replantations.
  
  
  METHODS
  Data was collected retrospectively from 389 digital replantations performed in our centre over an 11 year period. We included only single level digital replantations. We analysed the perioperative data, and the measures taken postoperatively to promote their survival.
  
  
  RESULTS
  There were a total of 137 troubled digits (35.2%). 53 digits responded to non-surgical measures such as dressing change and bedside bleeding procedures. 27 digits required re-exploration surgery, of which 16 survived. The majority of troubled replantations were due to arterial causes, and manifested signs within the first 48 h. 69 troubled digits (51%) survived. The remainder did not respond to any form of treatment including re-explorations and ultimately failed.
  
  
  CONCLUSIONS
  One third of all replantations are troubled replantations, and half of these eventually fail despite any intervention. As troubled replantations can lead to postoperative failure, it is important to understand this clinical scenario in order to improve immediate postoperative care.
authors.affiliation: Hand and Microsurgery Section, Department of Orthopaedics, Tan Tock Seng Hospital, Singapore 308433, Singapore.
authors.forename: Dawn Sinn Yii
authors.initials: DS
authors.lastname: Chia
authors.forename: Shian Chao
authors.initials: SC
authors.lastname: Tay
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000673:Amputation, Traumatic / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D015897:Comorbidity; D005260:Female; D005383:Finger Injuries / Q000601:surgery*; D006801:Humans; D007223:Infant; D008297:Male; D008866:Microsurgery; D008875:Middle Aged; D012086:Reoperation; D012092:Replantation / Q000379:methods*; D012189:Retrospective Studies; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures
keywords: Amputation; Failing Replantation; Microsurgery; Replantation; Revascularisation