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European Journal of Trauma and Emergency Surgery

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Open Access 20-01-2022 | Original Article

Risk and prognostic factors of replantation failure in patients with severe traumatic major limb mutilation

Authors: Chang Gao, Ling Yang, Jihui Ju, Ye Gao, Keran Zhang, Mingming Wu, Lijuan Yang, Xiaoting Lu, Ruixing Hou, Qiang Guo

Published in: European Journal of Trauma and Emergency Surgery | Issue 4/2022

Abstract

Purpose

Traumatic mutilation of major limbs can result in limb loss, motor disability, or death. Patients who had replantation failure needed to undergo additional surgeries (even amputation) and had a longer length of hospital stay. Here, we determined the risk and prognostic factors of replantation failure in patients with traumatic major limb mutilation.

Methods

This retrospective study included adult inpatients with severed traumatic major limb mutilation who underwent replantation from Suzhou Ruixing Medical Group from October 18, 2016 to July 31, 2020. Demographic, and clinical characteristics including traumatic conditions, laboratory findings, mangled extremity severity scores (MESS), treatments, and outcomes of the patients were collected. Data were used to analyze predictors and risk factors for replantation failure.

Results

Among the 66 patients, 48 (72.7%) were males, the median age was 47.0 years old. Replantation failure occurred in 48 patients (72.7%). The area under the curve of the joint prediction of lactic acid on admission, 72-h cumulative fluid balance, and albumin level immediately postoperatively was 0.838 (95% confidence interval [CI], 0.722–0.954; P < 0.001) with a sensitivity of 89.7% and a specificity of 69.2%. Lower limb trauma (odds ratio [OR] 8.65, 95% CI 1.64–45.56, P = 0.011), mangled extremity severity scores (OR 2.24, 95% CI 1.25–4.01, P = 0.007), and first 72-h cumulative fluid balance > 4885.6 mL (OR 10.25, 95% CI 1.37–76.93, P = 0.024) were independent risk factors for replantation failure.

Conclusions

Lower limb trauma, mangled extremity severity scores, and cumulative water balance were associated with replantation failure, implying that fluid management is necessary for major limb salvage. More studies are needed to explore the predictive power of indicators related to tissue oxygenation and wound healing for replantation failure.

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Title: Risk and prognostic factors of replantation failure in patients with severe traumatic major limb mutilation
Authors: Chang Gao
Ling Yang
Jihui Ju
Ye Gao
Keran Zhang
Mingming Wu
Lijuan Yang
Xiaoting Lu
Ruixing Hou
Qiang Guo
Publication date: 20-01-2022
Publisher: Springer Berlin Heidelberg
Published in: European Journal of Trauma and Emergency Surgery / Issue 4/2022
Print ISSN: 1863-9933
Electronic ISSN: 1863-9941
DOI: https://doi.org/10.1007/s00068-021-01876-w

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Risk and prognostic factors of replantation failure in patients with severe traumatic major limb mutilation

Abstract

Purpose

Methods

Results

Conclusions

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

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