Predictors for Necrosis after Single-Digit Replantation: A Retrospective Analysis of 946 Patients

Abstract

Background: Digital necrosis (DN) is a serious complication after replantation. However, predisposing factors, as reported less, remain controversial. The purpose of this study was to explore risk factors of necrosis after single-digit replantation by means of a retrospective study. Methods: Patients who underwent single-digit replantations in our hospital between June of 2014 and October of 2020 were included. The authors regarded DN as the failure group and digital survival as the success group. The factors were conducted by univariate and multivariate analysis. Results: The survival rate in our study was 78.8% (745 of 946). The results of univariate analysis showed that there were significant differences in the levels of D-dimer (first), menstrual cycle, injury level, and starting and finishing time of surgery between different groups. In multivariate analysis, age, injury level, duration of surgery, and D-dimer (first) were identified as the risk factors for DN in the entire and male population. In addition, regarding male patients, ischemia time was also found to be a risk factor for DN. In terms of female patients, the menstrual period and menopause were related to DN. Conclusions: Many factors, including age, ischemia time, injury level, menstrual period, menopause, and duration of surgery, were related to DN after digital replantation. D-dimer (first) was first found as a predicted factor for DN. In addition, these results also showed that the starting and ending times of surgery were associated with DN by univariate analysis. Preoperative measures should be taken to lower the incidence of DN. CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, III.