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Phytoparasitic nematodes are commonly found in the soil and their presence can lead to plant diseases, weaker growth, reduced yields and lower fruit quality. A study conducted in 2006–2009, involving the monitoring of climatic conditions, identified the influence of precipitation and temperature on the number of nematodes, in 7 sites within a cherry orchard. Soil samples to assess nematode populations were taken from 7 sites that differed in terms of cultivation and age: 5 cherry orchards established in different years. Not all nematode taxa responded in the same way to temperature increase. Members of the families Belonolaimidae, Trichodoridae and the genus Aphelenchus increased in number with rising temperatures. The negative water balance limited the number of nematodes in the soil in the layer up to 30 cm, whereas the increase in soil moisture had a positive effect on the development of Paratylenchus spp., and mebers of the family Hoplolaimidae and Heterodera. The largest total number of nematodes was found on the strip cultivated with agricultural crops after orchard liquidation. However, parasitic nematodes accounted for were at low levels (17%). The size of fruits from trees growing on sites with a large number of nematodes decreased with a simultaneous increase in total soluble solids and fruit firmness.

Major self-mutilations include injury to limbs, eyes, or genitals due to various psychiatric illnesses. Limb amputations are grievous injuries that radically decrease the quality of life. Controversy exists as to the advisability of replantation of the self-amputated limb. We report a case of self-amputation of the hand in a 54-year-old gentleman in a fit of psychosis. He underwent replantation of the hand and was given timely psychiatric help. Interdisciplinary management helped in improving the mood of the patient and he cooperated well with the rehabilitation schedule. Recent literature encourages surgeons to replant the limb and treat the mental illness with close observation for warning signs. We conclude that replantation along with early initiation of psychiatry treatment can help the patient overcome psychosis, realize the implications of his actions, and provide the motivation to perform physiotherapy to achieve the optimum outcome possible in the replanted hand. [ABSTRACT FROM AUTHOR]

Objective: In this prospective case series, the effects of flapless intentional replantation (IR) with root surface conditioning with enamel matrix derivative (EMD) was evaluated for the treatment of periodontally-endodontally involved hopeless teeth. Method and Materials: A total of 17 teeth (17 patients, aged 40 to 73) with = 10 mm attachment loss and radiographic bone loss to the apex were included in the study. The affected teeth were atraumatically extracted using a flapless approach, then granulation tissues, calculus, and necrotic cementum on the root surfaces were removed. EMD was applied for 5 minutes to the root surfaces. The teeth were reinserted to the socket without any bone grafts and splinted. Results: After 2 years, clinical healing was uneventful in 16 cases and the radiographs revealed no root resorption or ankylosis. IR with EMD treatment provided statistically significant reduction in probing depth (6.4 ± 2.6 mm), gain in clinical attachment level (5.9 ± 2.5 mm), and gain in radiographic bone level (48.2 ± 26.1%) compared to baseline values (P < .01). Conclusion: Within the limitations of the study, flapless IR with EMD treatment appeared to act as an alternative strategy to extraction of severely compromised teeth with endodontic-periodontal lesions beyond the root apex. [ABSTRACT FROM AUTHOR]

This article reports a clinical case of a 10-year-old boy who sustained an avulsion of the maxillary right central incisor. The avulsed tooth was kept in adverse extraoral dry conditions for 26 hours from the moment of trauma until its replantation. Treatment guidelines for avulsed mature permanent teeth with closed apex were only partially followed. However, the clinical and radiographic findings after 10 years revealed acceptable functional outcome, in spite of ankylosis and root resorption of the replanted tooth, which was eventually treated cosmetically. [ABSTRACT FROM AUTHOR]

The management of complex upper extremity trauma can be overwhelming in its urgency and complexity. Having a systematic approach that maintains a clear set of priorities focused on hand and upper extremity function, operative efficiency, and long-term planning for future operations allows the reconstructive extremity surgeon to effectively treat these complex injuries. This article addressed these overall clinical considerations and details the approach taken at the Buncke Clinic including replantation and revascularization as well as osseous and soft tissue reconstruction. [ABSTRACT FROM AUTHOR]

A historical review of the history of Microsurgery including the important influence and contributions of Harry J. Buncke MD considered by many to be the "Father of Microsurgery". An chronological list of Historic Replants and "Free Flap" and microvascular transplants is included. Those who lived through the age of the birth of this new surgical specialty were fortunate. [ABSTRACT FROM AUTHOR]

Foot injuries due to vehicular or other accidents are common. However, complete toe amputation is rare. This study explored the current protocols and clinical significance of toe replantation. From December 2011 to December 2018, ten patients with 13 severed toes underwent toe replantation in our hospital. Seven cases were replanted antegrade, and three cases were replanted retrograde. All patients were followed for two to three years after toe replantation. One big toe underwent necrosis, while the other 12 toes survived completely. The appearance and feel of the successfully replanted toes were satisfactory, and the patients exhibited a normal gait. Toe replantation can achieve an acceptable appearance and function of the foot and considerably reduce the psychological effects experienced by the patients. Increased clinical attention and application of toe replantation are needed. Level of Evidence: Level IV, retrospective case series [ABSTRACT FROM AUTHOR]

Phytoparasitic nematodes are commonly found in the soil and their presence can lead to plant diseases, weaker growth, reduced yields and lower fruit quality. A study conducted in 2006–2009, involving the monitoring of climatic conditions, identified the influence of precipitation and temperature on the number of nematodes, in 7 sites within a cherry orchard. Soil samples to assess nematode populations were taken from 7 sites that differed in terms of cultivation and age: 5 cherry orchards established in different years. Not all nematode taxa responded in the same way to temperature increase. Members of the families Belonolaimidae, Trichodoridae and the genus Aphelenchus increased in number with rising temperatures. The negative water balance limited the number of nematodes in the soil in the layer up to 30 cm, whereas the increase in soil moisture had a positive effect on the development of Paratylenchus spp., and mebers of the family Hoplolaimidae and Heterodera. The largest total number of nematodes was found on the strip cultivated with agricultural crops after orchard liquidation. However, parasitic nematodes accounted for were at low levels (17%). The size of fruits from trees growing on sites with a large number of nematodes decreased with a simultaneous increase in total soluble solids and fruit firmness. [ABSTRACT FROM AUTHOR]

AIM: To assess the level of awareness and also to create awareness about the management of avulsed tooth among dental students. BACKGROUND: The complete displacement of a tooth from its socket due to accidental or non accidental injuries that may cause loss of healthy teeth is termed as the tooth avulsion. Success of tooth replantation depends on extraalveolar dry time, storage media, type of retention, time of endodontic treatment, type of drug prescribed, oral hygiene status of the victim as well as the general health. Preventing the dehydration of the avulsed tooth and also minimizing the root manipulation are very important for preserving the periodontal ligament cells. MATERIALS AND METHOD: A questionnaire was prepared, comprising 13 questions with the sample size of 100 dental students. The results were analyzed using SPSS version 23 and the method of representing each output variable was a bar graph. Chi square test was done to check the association, and a p-value of 0.05 was said to be statistically significant. RESULTS AND DISCUSSION: 44% chose less than 60 minutes as the ideal time for replantation of an avulsed tooth. 33% of IVth year students reported 4 weeks as the splinting period for an avulsed tooth with a dry time of more than 60 minutes. 30% of IVth year students reported semi rigid as the type of splint used in the replantation of an avulsed tooth. 32% of IVth year students reported extra alveolar dry time as the most critical factor in the outcome of the replanted tooth. Association between the study year and the awareness on the splinting period of an avulsed tooth with a dry time of 60 mins(p=0.00), replantation of primary tooth(p=0.028), type of used in replantation of tooth(p=0.00), and the critical factor in the outcome of replanted tooth(p=0.00) showed a statistically significant difference. CONCLUSION: The present study reveals the knowledge and awareness among the dental students on the management of avulsed tooth. The results of this survey show that the majority were the IVth year students who were aware about the tooth avulsion, its replantation and treatment than the Ist year, IInd year, IIIrd year and Vth year students. [ABSTRACT FROM AUTHOR]

Penile amputation is an uncommon surgical emergency in the urology field. Surgical replantation is one of the treatment options. The role of Doppler ultrasound in the post-operative period has not been sufficiently evaluated. We faced an equivocal condition in the case of penile replantation. This study is a report of this patient and a systematic review evaluating the available literature on the role of Doppler ultrasonography in this rare clinical condition. This is a case report of a patient with self-mutilation of the penis due to a psychological disorder managed by microsurgical replantation of the penis in which the early post-operative Doppler ultrasound results showed no arterial blood flow but the final result was quite satisfying. We performed a systematic review then to find the universal experience with Doppler ultrasound in penile replantation. We found a total of 14 reports that used Doppler ultrasound after penile replantation. These reports are quite rare and heterogeneous in terms of evaluation time and findings. We here summarized the results of all these studies narratively. Our experience - like two other studies included in this systematic review - shows that relying merely on the results of early post-operative Doppler ultrasound especially when it shows inappropriate blood flow, is not sufficient since the clinical result achieved with routine followup can be quite satisfactory in long term. [ABSTRACT FROM AUTHOR]

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Objective: Infection after total knee arthroplasty (TKA) is a rare but devastating complication. Different types of spaces have been used in two‐stage revision. The study aimed to evaluate the effect of autoclaved femoral and tibial components as spacers for treating periprosthetic infections after TKA. Methods: A retrospective study was performed for 13 patients (five males, eight females) with a mean age of 69 ± 6 (range, 57–80) years and suffering from periprosthetic infection after TKA. They were treated with unconventional two‐stage revision from May 2008 to June 2017. In the first‐stage surgery, the autoclaved femoral and tibial components were reimplanted with a new liner as a spacer after a thorough debridement. After 4–6 months, the second‐stage surgery was performed according to the patients' requirements. The knee society score (KSS) and knee range of motion (ROM) were assessed before and after surgery. The reinfection rate was calculated. Results: The mean duration of follow‐up was 5.7 ± 2.1 (range, 3.1–8.8) years. Culture‐positive infections comprised 69% of the cohort. All patients were able to walk 24 h after the first stage surgery, and the knee ROM could reach 90° in 1 week. Two patients (15.4%) experienced an infection recurrence. One patient was reinfected 1 year after the first stage surgery. Another patient developed reinfection 3 years after surgery but did not choose re‐revision and died of pneumonia. Only one patient underwent the second stage revision. The remaining 10 patients refused to receive a new prosthesis. At the time of the final follow‐up, six patients had slight pain in the knee while walking, and one patient required crutches to walk. There were no signs of prosthesis dislocation, rupture, deep vein thrombosis, pulmonary embolism, or delayed wound healing. No radiolucent lines or osteolysis were found. The mean KSS improved from 51 ± 10 (range, 35–63) points preoperatively to 79 ± 5 (range, 60–85) points at the final follow‐up. The average ROM before and after the first stage surgery were 62° ± 29° (range, 10°–100°) and 104° ± 9° (range, 90°–120°) (t = 4.659, P < 0.01) respectively. The infection control rate was 84.6%. Conclusion: Reimplantation of the autoclaved original femoral and tibial components as an articulating spacer during the first stage surgery is a valuable addition for treating an infected TKA. [ABSTRACT FROM AUTHOR]

After replantation and salvage procedures have failed in a heavy smoker, surgeons are hesitant to consider future strategies. We introduce a case in which the length and function of the right thumb were preserved as much as possible by double flap surgery after replantation failure. The thumb of a 55-year-old man without underlying disease was amputated by an electrical chainsaw at work. He presented at the emergency room of our hospital, and emergency surgery was performed for exploration and stump replantation. Unfortunately, the replantation surgery failed, and the distal stump was necrotized. Thus, double flap surgery was planned after replantation failure, and thumb reconstruction was performed using a reverse homodigital dorsoulnar flap and a cross-finger flap. A portion of the flap later had to be revised, but the functional and aesthetic results obtained were far better than expected for a simple stump revision procedure. [ABSTRACT FROM AUTHOR]

Purpose: Unfractionated heparin (UFH) is more commonly used as an anticoagulant after digital replantation than low-molecular-weight heparin (LMWH). We compared the success and complication rates of these two anticoagulants, since only a few studies have made this comparison directly. Methods: Forty-four patients who underwent digital replantation for complete or incomplete digital amputation in the past 7 years at a single institution were included. The patients were divided into LMWH and UFH groups according to the anticoagulant administered. The success rates for each group were obtained, and the postoperative serum aspartate aminotransferase (AST) and alanine transaminase (ALT) levels were analyzed to compare the complication rates. Results: All patients, except one, had successful recovery of circulation after replantation, and the success rate did not show a statistically significant difference between the two groups. The statistical analysis showed that the proportion of patients with abnormal serum AST or ALT levels in the LMWH group was significantly lower than that in the UFH group. Conclusion: Although there was no significant difference in the success rate between the two groups, the risk of hepatotoxicity was significantly lower in the LMWH group than in the UFH group. Considering the advantages of LMWH, its extensive use is highly recommended for anticoagulation therapy in patients after digital replantation. [ABSTRACT FROM AUTHOR]

The primary aim of this study was to report outcomes after fingertip terminalization in 90 patients over a 19-year period. We report excellent functional outcomes and satisfaction, but a 33% incidence of neuropathic pain., Competing Interests: Declaration of conflicting interestsThe authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Background: Saw injuries are common, with more 75 000 occurring each year in the United States alone. While these injuries occur frequently, management strategies are not universally agreed upon, and data regarding outcomes and complications are lacking. We propose to provide a comprehensive picture of upper extremity saw injury patterns, management strategies, complications, and outcomes., Methods: Patients presenting to a single level 1 trauma center between 2012 and2019 with upper extremity laceration, crush, or amputation were identified. In all, 10 721 patients were reviewed, and those without wood saw injuries were excluded. Patient demographic information, injury details, management strategy, and outcomes were collected., Results: In all, 283 upper extremity wood saw injuries were analyzed. Injuries most commonly affected the fingers (92.2%), and the frequencies of simple lacerations and complicated injuries were nearly identical. The table saw was the most commonly implicated saw (48%) with more than half of the injuries being complicated, the most common being bone injury. Most patients were treated nonsurgically (81.3%), with the majority undergoing wound care in the emergency department followed by home antibiotics (68.2%). Subsequent complications were exceedingly rare (4.2%), with wound infection occurring in 5 patients. Amputations occurred in 19.4% of patients, leading to permanent functional impairment., Conclusions: Wood saw injuries are common, generating functional and financial burden. While injuries range in severity, management can typically be conducted within the emergency department with local wound care and outpatient oral antibiotics. Injury complications and long-term issues are rare. Ongoing efforts to promote saw safety are required to minimize the burden of these injuries., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

There have been dwindling numbers of replantations in the United States. Despite the advocacy for centralization in hand trauma, the fundamental landscape and attitudes of surgeons toward replantation have remained lackluster. There is growing and substantial evidence to demonstrate the superior outcomes of replantation in comparison to revision amputation in most scenarios. This article aims to delve into the factors contributing to the decreasing numbers of replantations and proposes strategies to overcome this issue., Competing Interests: Disclosure The authors of this article declare that they have no financial interests or conflicts that could influence the views or conclusions presented in this article. No external funding or financial support was received for this study. The authors have no affiliations with organizations or entities that may have a direct or indirect interest in the subject matter discussed in this article. This work has not been previously published or submitted for publication elsewhere., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Work in agriculture carries the risk of trauma as a result of mechanization (farm equipment and machinery), location of cultivated areas, and multi-functionality. In agriculture, the hands were the most affected parts of the body which sustained injury. Successful suturing of a finger initially disqualified from replantation is rare. The case is presented of a 55-year-old patient who had a non-work-related finger amputation. In a surgical centre not belonging to the reference ones in plastic surgery in Poland, a doctor with six months of surgical experience performed the replantation without vascular reconstruction (the amputated distal part of the finger served as a biological dressing). Despite the lack of vascular reconstruction and unfavourable prognosis, the amputated fragment of the finger maintained a partial blood supply. Subsequent flap surgery in the plastic surgery department, and rehabilitation of the patient due to finger contracture, led to functional recovery of the finger.

Introduction: For patients unsuitable for prosthesis reimplantation or temporary spacer placement, Girdlestone resection arthroplasty (GRA) is a suitable option to eliminate infection. Using a large-scale database, this study aims to determine factors associated with reimplantation., Methods: This study included patients who underwent GRA and subsequent total hip arthroplasty (2012 to 2015 Medicare Limited Data Set with ≥5-year follow-up). A mixed-effects model measured associations between patient characteristics and reimplantation. Odds ratios (OR) with 95% confidence intervals (CI) were reported., Results: Among 2,772 GRA cases, 2,025 (73.1%) were reimplanted (median time to reimplantation 3.0 months). In multivariable analysis, patient factors associated with reduced odds of reimplantation were increased age (OR 0.96; CI, 0.94 to 0.97; P < 0.0001), Black race (OR, 0.58; CI, 0.37 to 0.90; P = 0.0149), obesity (OR, 0.74; CI, 0.58 to 0.94; P = 0.0150), and increased Deyo-Charlson comorbidities (1 comorbidity: OR, 0.78; CI, 0.61 to 0.99; P = 0.0453; two comorbidities: OR, 0.53; CI, 0.39 to 0.71; P < 0.0001; ≥3 comorbidities: OR, 0.69; CI, 0.49 to 0.95; P = 0.0244). Male (versus female) patients, however, had increased odds of reimplantation (OR, 1.64; CI, 1.32 to 2.02; P < 0.0001)., Discussion: Age, race, and comorbidities influence the likelihood of reimplantation after GRA. Owing to variability in patients who undergo additional surgery, additional studies should be conducted to determine the rationale of patient selection., (Copyright © 2024 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of the American Academy of Orthopaedic Surgeons.)

The aims of this study were to record patient-reported outcomes of treatment of proximal upper extremity amputation injuries and subsequent return to work. A consecutive cohort of 38 patients with a traumatic amputation at or proximal to the carpus had been treated with a replantation or revision (completion) amputation in Tampere University Hospital between 2009 and 2019, and 31 of them participated in this study. The primary outcome was the Disabilities of the Arm, Shoulder and Hand Outcome Measure (DASH). Patients reported significant disability indicated by DASH score after replantation (median 30; interquartile range [IQR] 21-47) and revision (completion) amputation (median 33; IQR 16-52). Most patients had cold intolerance and reported low hand function and aesthetics scores. Out of 17 working patients, 10 did not return to their previous work. Our study demonstrates the influence of major upper extremity amputation on daily life activities, even after a successful replantation. Level of evidence : IV., Competing Interests: Declaration of conflicting interestsThe authors declare no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Introduction: This study aims to evaluate the long-term psychosocial and functional outcomes of successful digital replantation following traumatic amputation., Methods: Patients that underwent successful replantation (i.e. no secondary amputation following replantation) of one or more traumatically amputated digits between January 2009 and April 2019 were invited to participate in this study. In addition to a custom questionnaire on psychosocial and socioeconomic aspects of life, various Patient-Reported Outcomes Measurement Information System (PROMIS) questionnaires regarding global health, upper extremity function, and depressive symptoms were completed. Bivariate analyses were performed to identify significant associations between outcomes and explanatory variables., Results: Thirty-six patients were successfully enrolled and completed the questionnaires at a median follow-up of 6.1 years. The median PROMIS score for Upper Extremity Function (40.6) was considerably different from the score that is typically found in the general population (all PROMIS instruments are calibrated with a control group score of 50.0), but the median PROMIS scores for Global Health - Physical (49.0), Global Health - Mental (50.7), and Depression (45.6) were comparable to those among the general population. Dominant hand injury, a greater number of injured digits, higher age at the time of injury, and the need for neuropathic pain medication were associated with lower Upper Extremity Function scores (all p < 0.05). Additionally, the presence of neuroma was associated with negative changes in both household finances and mental well-being (p < 0.05)., Conclusions: At long-term follow-up, a majority of patients that underwent replantation of traumatically amputated digits seem to cope well based on psychosocial and functional outcomes. However, neuropathic pain and the presence of neuroma are strong negative factors. Specific attention to digital nerves at the time of surgery is crucial in the management of traumatic amputations., (Copyright © 2024 SFCM. Published by Elsevier Masson SAS. All rights reserved.)

The article highlights the generalized research data of the Department of Horticulture, Viticulture, Biology and Chemistry of Odessa State University. The main direction of its work is to maintain the productivity of existing plantations and the formation of high-yielding plantations of grapes of technical varieties in the Northern Black Sea region of Ukraine. Based on many years of research, the productivity of vineyards of Aligote, Traminer pink, White fetish, Chardonnay, Pinot Noir, Cabernet Sauvignon and many others has been established, as well as complex schemes of impact on young grape bushes and plantations older than 25 years. As a result of researches, the basic optimum terms for conditions of the South of Ukraine in which it is necessary to carry out processing by growth stimulators and root and foliar feeding are established. These terms are: the first treatment before flowering, the second when the berries reach the size of a pea and the third at the beginning of ripening berries. It is proved that the after-effect of application of fertilizing elements is intensified on old plantations after the renewal of the plantation and can last up to three years, depending on the wet supply of the territory. The main conclusions and proposals for the use of complexes of agricultural technology elements based on root and foliar nutrition with different substances, irrigation, periodic deep tillage is given. Based on the obtained results, a mathematical model of quality management of grape products and products of its processing is developed

Former amputees who undergo allogeneic hand transplantation or autogenic hand replantation (jointly, “hand restoration”) present a unique opportunity to measure the range of post-deafferentation plastic changes in the nervous system, especially primary somatosensory cortex (S1). However, few such patients exist, and previous studies compared single cases to small groups of typical adults. Here, we studied 5 individuals (n = 8 sessions: a transplant with 2 sessions, a transplant with 3 sessions, and three replants with 1 session each). We used functional magnetic resonance imaging (fMRI) to measure S1 responsiveness to controlled pneumatic tactile stimulation delivered to each patient's left and right fingertips and lower face. These data were compared with responses acquired from typical adults (n = 29) and current unilateral amputees (n = 19). During stimulation of the affected hand, patients' affected S1 (contralateral to affected hand) responded to stimulation in a manner similar both to amputees and to typical adults. The presence of contralateral responses indicated grossly typical S1 function, but responses were universally at the low end of the range of typical variability. Patients' affected S1 showed substantial individual variability in responses to stimulation of the intact hand: while all patients fell within the range of typical adults, some patient sessions (4/8) had substantial ipsilateral responses similar to those exhibited by current amputees. Unlike hand restoration patients, current amputees exhibited substantial S1 reorganization compared to typical adults, including bilateral S1 responses to stimulation of the intact hand. In all three participant groups, we assessed tactile localization by measuring individuals' ability to identify the location of touch on the palm and fingers. Curiously, while transplant patients improved their tactile sensory localization over time, this was uncorrelated with changes in S1 responses to tactile stimuli. Overall, our results provide the first description of cortical responses to well-controlled tactile stimulation after hand restoration. Our case studies indicate that hand restoration patients show S1 function within the range of both typical adults and amputees, but with low-amplitude and individual-specific responses that indicate a wide range of potential cortical neurological changes following de-afferentation and re-afferentation.

Increasingly, in orchards around the world that are planted one after another, disturbances are observed, and these issues with growth and development are called replantation disease. It is manifested mainly by poor tree growth after planting and poor ripening. One way to reduce replantation disease is to improve soil fertility after many years of fruit tree cultivation. The aim of the work was to evaluate the growth and yield of cherries after replantation and to compare this with a site where fruit trees had not grown before. The trees were planted at two sites: after the replantation of the cherry orchard (OR1) and in a site where fruit trees had not been cultivated before (OR2). Two combinations were used in each orchard: boiler without mulching (C), mulch—after planting mulching with a substrate after growing mushrooms (M). The trees at the site after replantation grew and bore less fruit than in the position where fruit trees had not grown before. The disease also affected some of the quality characteristics of the fruit. This resulted in an increase in fruit weight and a darker color (L*) and a higher value of hue fruit color. Mulching, which is often recommended in orchards planted after previous cultivation, did not provide the expected improvement. It did not significantly affect tree growth and yield. Only an effect on the content of components in the soil was observed, but it affected the condition of the trees. In addition, we analyzed how experimental combinations responded to climatic conditions by calculating the correlations between the SAT (sum of active temperatures) and the stages of tree development.

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. [ABSTRACT FROM AUTHOR]

Background: The success of digit replantation is mainly based on survival rates. The functional outcome as well as the recovery of sensibility are essential parameters for judging the outcome after digit replantation but have been poorly assessed in previous studies.Patients and Methods: Forty-eight patients with 56 complete traumatic digit amputations occurring between 2008 and 2013 returned for a follow-up examination, the earliest being 6 months postoperatively. Each patient's range of motion, fingertip-to-table distance, fingertip-to-palm distance, grip and pinch strengths, static two-point discrimination (2-PD), and Semmes-Weinstein monofilament (SWM) test level were assessed in order to compare functional outcome and recovery of sensibility between successful replantation (n = 19) and primary or secondary amputation (n = 37). Subjective assessments of the pain level and function of the upper extremity were performed using the numerical rating scale and the DASH score, respectively.Results: Replanted digits achieved 58% of the median total range of motion of the corresponding uninjured digits. Grip and pinch strength were not significantly different after thumb or finger replantation or amputation. Recovery of sensibility was excellent after replantation, with a median static 2-PD of 5 mm and a reduction of pressure sensibility of two levels of the SWM test compared to the contralateral side. After amputation, the median static 2-PD was also very good, with a median value of 6 mm and a reduction of pressure sensibility of only one level according to the SWM test. There was significantly less pain after replantation at rest (p = 0.012) and under strain (p = 0.012) compared to patients after amputation. No significant differences were observed in the DASH score between the two groups.Conclusion: Comparable functional results and sensory recovery but significantly less pain at rest and under strain can be expected after digit replantation when compared to digit amputation.Level Of Evidence: IV. [ABSTRACT FROM AUTHOR]

Objective To explore the methods of replantation and rehabilitation of multi-planar disarticulation injuries of hand. Methods From April 2014 to January 2021, 15 patients with multi-planar disarticulation injuries of hand (58 segments) underwent replantation surgery. There were 1 case of broken wrist, broken palm and broken finger (3 segments), 2 cases of broken wrist and broken palm (4 segments), 6 cases of broken palm and broken finger (29 segments) and 6 cases of multi-planar disarticulation injuries of fingers (22 segments). Preoperative evaluation and postoperative rehabilitation training were performed. Results In 15 patients (58 segments), 54 segments were replanted and survived. The survival rate of replantation was 93.1%. The postoperative follow-up ranged from 3 to 20 months, with an average of 9 months. The replanted segments had good skin texture and appearance. The sensory recovery was from S2 to S4 and the two-point discrimination was from 6 to 12 mm. According to the trial standard of the Chinese Society of Hand Surgery for the evaluation of function of the replanted finger, the excellent and good rate of hand function was 80%. Conclusion Preoperative evaluation, intraoperative rapid replantation and postoperative rehabilitation of multi-planar disarticulation injuries of hand can achieve satisfactory survival rates and clinical outcomes. [ABSTRACT FROM AUTHOR]

One of the reasons for unsuccessful replantation is recipient site problems. In cases where proximal stump status cannot be predicted exactly, reamputation may be required depending on the result of infection and tissue necrosis. The ectopic banking method has been defined for this type of injury. In this study, we presented the amputated or devascularized upper extremity digit ectopic banking application results in our clinical practice. Nineteen digits (17 patients) banking ectopically were included in the study. All digits ectopically banked in the forearm volar of the non-injured upper limb. Transfers were made after waiting for the appropriate time. Ectopic banking periods, postoperative complications, and other descriptive data were recorded. In the postoperative 6th month, the range of motion (ROM) values of the digits were measured and compared with the ROM values of the same digit on the non-injured extremity.Also, in the postoperative 6th month, a questionnaire with a score of 1–5 was conducted for cosmetic results. The mean follow-up time was 13.6 months. The mean patient age was 39.5 years. The ectopic banking success rate is 94.1% (16/17). The orthotopic/heterotopic transfer success rate is 100% (17/17). Ectopic banking time is, on average, 19.2 days (min 5–max 55). Average cosmetic scale is 3.54. We think that the results of our study will shed light on surgeons who make ectopic banking applications. [ABSTRACT FROM AUTHOR]

Forearm replantation is a challenging procedure for both patients and medical professionals. High survival rates are now being achieved owing to developments in microsurgical techniques. However, patient expectations for a "functional hand" are ever-increasing. To obtain satisfactory functional results following major limb replantation, it is important to reduce the ischemic time. During forearm replantation, the time from the beginning of surgery to the anastomosis of the artery should be minimized. This step includes anesthesia, wound debridement, and bone fixation, which are key factors in choosing the most efficient method and reducing the time needed. Herein, we review the prognostic factors and report the general operative procedures for forearm replantation using our proposed surgical technique. [ABSTRACT FROM AUTHOR]

Objective To investigate the influencing factors of survival rate after replantation of severed palm and fingers and related nursing strategies. Methods The clinical data of 68 patients undergoing replantation of severed palm or severed finger were retrospectively analyzed. Univariate analysis and logistic regression model were performed to identify potential factors influencing the survival rate after replantation. Results There were 43 patients whose amputated finger(s) or palm survived after replantation. The logistic regressive analysis showed that completely severed injury, long time before admission, poor elasticity of the soft tissues of the finger pulp, poor capillary refilling reaction after surgery, purple or blue finger(s), development of thrombosis, vasospasm and severe anxiety were independent factors influencing the survival rate after replantation. Conclusion Influencing factors of survival rate after replantation included completely severed injury, long time before admission, low skin temperature after surgery, poor elasticity of the soft tissues of the finger pulp, poor capillary refilling reaction after surgery, purple or blue finger, development of thrombosis, vasospasm and severe anxiety. Targeted nursing interventions should be carried out to improve the survival rate after replantation. (目的 探讨断指断掌再植术后影响成活率的相关因素及护理对策。方法 回顾性分析2013年1月—2019年12月医院骨外科收治的68例断指断掌行再植术患者的临床资料, 应用Logistic回归分析影响再植成活率的危险因素, 并探讨相应的护理措施。结果 68例患者中再植成活43例, 再植未成活25例。Logistic回归分析结果显示, 完全离断、伤后就诊时间长 、术后指腹弹性差 、术后毛细血管反应差 、术后断指颜色一般 、有血栓形成 、有血管痉挛 、重度焦虑为影响断指断掌再植术后成活率的独立危险因素 (P

ObjectiveTo evaluate the success of urethroplasty for urethral strictures arising after erosion of an artificial urinary sphincter (AUS) and rates of subsequent AUS replacement.Patients and methodsFrom 2009-2016, we identified patients from the Trauma and Urologic Reconstruction Network of Surgeons and several other centers. We included patients with urethral strictures arising from AUS erosion undergoing urethroplasty with or without subsequent AUS replacement. We retrospectively reviewed patient demographics, history, stricture characteristics, and outcomes. Variables in patients with and without complications after AUS replacement were compared using chi-square test, independent samples t test, and Mann-Whitney U test when appropriate.ResultsThirty-one men were identified with the inclusion criteria. Radical prostatectomy was the etiology of incontinence in 87% of the patients, and 29% had radiation therapy. Anastomotic (28) and buccal graft substitution (3) urethroplasty were performed. Follow-up cystoscopy was done in 28 patients (median 4.5 months, interquartile range [IQR]: 3-8) showing no urethral stricture recurrences. Median overall follow-up was 22.0 months (IQR: 15-38). In 27 men (87%), AUS was replaced at median of 6.0 months (IQR: 4-7) after urethroplasty. In 25 patients with >3 months of follow-up after AUS replacement, urethral complications requiring AUS revision or removal occurred in 9 patients (36%) and included subcuff atrophy (3) and erosion (6). Mean length of stricture was higher in patients who developed a complication after urethroplasty and AUS replacement (2.2 vs. 1.5 cm, P = .04).ConclusionIn patients with urethral stricture after AUS erosion, urethroplasty is successful. However, AUS replacement after urethroplasty has a high erosion rate even in the short-term.

Growing apple trees in intensive production systems increasingly leads to long-term use of one site for several generations of orchards. Due to zoning, ownership restrictions and investments in orchard infrastructure, such as supporting systems, irrigation, fencing, etc., growers are forced to re-plant new trees on the same land. However, this method of management sooner or later leads to the development of apple replant disease. Above all, its consequences are limited growth, reduced yields and thus a reduction in the economic benefits of the orchard. As part of the solution of the replant disease problem, we tested the possibility of mitigating its impacts by using soil from previous inter-rows that is potentially less affected by apple replant disease. Either soil from the original row (Únava) or from the original inter-row (Výměna) was used to cover the roots of newly planted apple trees in the original orchard lines. The evaluation of vegetative growth revealed a certain positive effect of soil exchange; however, no significant results were achieved. In the case of the yields, the results also did not show a significant difference. According to the methodology of our experiment, the exchange of soil from inter-rows proved to be insufficient in a four-year experiment. Better results could be achieved by combining soil replacement with other measures to reduce the effects of replant disease.

Factors associated with failure of digital revascularization and replantation procedures have been well characterized, but studies have not investigated failures occurring beyond the early postoperative period. A single-centre retrospective chart review included 284 patients (434 digits) who underwent digital revascularization or replantation. Patient-, injury- and surgery-related characteristics were compared among successful procedures, digits that failed while in hospital (early failure), and initially viable digits that failed after hospital discharge (late failure). Overall, 202 patients had successful procedures (71%). There were 51 early failures (18%) and 31 late failures (11%). Crush injuries and vein grafting were associated with early failure only. Complete amputations and leeching were strongly associated with both early and late failure. This study revealed that a substantial proportion of initially viable digits fail after discharge from hospital. Patients with signs of venous congestion may benefit from longer observation periods in hospital to avoid late failure. Level of evidence: IV [ABSTRACT FROM AUTHOR]

The long-term outcomes of osseointegration for digital amputations are not well established, and it is not known whether osseointegration can achieve similar function and patient satisfaction to conventional surgical options such as replantation and microsurgical toe transfer. We compared the long-term outcomes after digital osseointegration and replantation. Six patients treated by osseointegration and seven patients treated by replantation were included, with median follow-ups of 8 years and 4.6 years, respectively. Outcomes were assessed using the Michigan Hand Outcomes Questionnaire, grip and pinch strength, range of motion, two-point discrimination, Semmes-Weinstein tests, Jebsen-Taylor Hand Function Test and clinical photography. Osseointegration was associated with poorer sensibility and range of motion than replantation; no other differences reached statistical significance. Long-term osseointegration is a safe and effective reconstructive option that can deliver excellent outcomes in appropriately selected patients. Level of evidence: IV [ABSTRACT FROM AUTHOR]

Background: The number of anastomosed arteries and veins in replantation surgery of the hand is one of the most important factors in determining survival rate. Objective: To evaluate the surgical and functional outcomes of replantation after injuries in the hand with different ratios of the repaired arteries and veins. Patients and Methods: Twenty-one patients underwent replantation and revascularization procedures for hands and fingers amputation from April 2021 to the end of October 2021 in the Department of Plastic Surgery at Zagazig University Hospitals. According to arterial/venous (AV) ratio in optimizing replantation they were grouped into 3 groups, group I AV ration < 1 vein, group II: AV ration = 1 vein, group III: AV ration > 1 vein and they were followed up for more than six months Results: There were a statistically significant increase in total active range of motion (TAM) degree among Group III compared to Group I and II. Regarding Chen criteria, there was a statistical significant increase in frequency of class I among Group III compared to Group I and Group II. There was a statistically significant -ve correlation between A/V ratio and TAM degree among the studied cases. Also, there was a statistical significant +ve correlation between A/V ratio and Chen criteria, two-point discrimination (2PD), and Q dash among the studied cases. Conclusion: All hand surgeons should be able to perform digital replantation. A successful vessel anastomosis ensures the viability of the replanted portion of the body. [ABSTRACT FROM AUTHOR]

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Amputation of the penis is a rare and devastating injury. The etiologies vary from accidental, self-inflicted to attacks due to sexual jealousy and revenge. In the present era of microvascular surgery, replantation is the standard care. However, replantation of the penis comes with its own set of difficulties and complications. Knowledge of the anatomy and prior knowledge of the possible complications makes the surgeon aware of the course of events after a replantation. It helps in devising strategies to overcome these challenges methodically. We present a case of penile replant with the complications that we encountered, and the measures are taken to counter them on our way to a successful outcome. [ABSTRACT FROM AUTHOR]

Recently, a decellularized microvascular graft (inner diameter: 0.6 mm) modified with the integrin α4β1 ligand, REDV, was developed to provide an alternative to autologous‐vein grafting in reconstructive microsurgery, showing good early‐stage patency under arterial flow in rats. This consecutive study evaluated its potential utility not only as an arterial substitute, but also as a venous substitute, using a rat‐tail replantation model. Graft remodeling depending on hemodynamic status was also investigated. ACI rat tail arteries were decellularized via ultra‐high‐hydrostatic pressure treatment and modified with REDV to induce antithrombogenic interfaces and promote endothelialization after implantation. Grafts were implanted into the tail artery and vein to re‐establish blood circulation in amputated Lewis rat tails (n = 12). The primary endpoint was the survival of replants. Secondary endpoints were graft patency, remodeling, and regeneration for 6 months. In all but three cases with technical errors or postoperative self‐mutilation, tails survived without any evidence of ischemia or congestion. Six‐month Kaplan–Meier patency was 100% for tail‐artery implanted grafts and 62% for tail‐vein implanted grafts. At 6 months, the neo‐tunica media (thickness: 95.0 μm in tail‐artery implanted grafts, 9.3 μm in tail‐vein implanted grafts) was regenerated inside the neo‐intima. In conclusion, the microvascular grafts functioned well both as arterial and venous paths of replanted‐rat tails, with different remodeling under arterial and venous conditions. [ABSTRACT FROM AUTHOR]

Introduction: The aim of this study was to present the therapeutic procedure and the outcome of replantation of the avulsed permanent central maxillary incisor, found at the site of high contamination, after an extraoral period of 15 hours and dry transport. Case report: By clinical examination it was determined that the root reached the full length, with parallel edges, which corresponded to the age of the girl-8.5 years. After carefully removing the necrotic periodontal ligament from the root of the tooth, extraoral endodontic treatment was performed. The pulp was removed, the multi-sessional intracanal medicament fillings were avoided and the definitive obturation of the root canal was performed. The tooth was returned to the alveolar socket and immobilized with a wire-composite splint. After replantation, the condition of the tooth was monitored. Replacement resorption and dentoalveolar ankylosis occurred after nine months, and then cervical inflammatory resorption led to tooth loss after three and a half years. Conclusion: The achieved result can be considered as a success because during this time the replanted tooth met the developmental, functional and aesthetic requirements, which is especially important in the period of intensive growth and development of the child.

Introduction: Permanent tooth avulsions (traumatic extraction; total luxation) are one ofthe most severe permanent tooth injuries and can occur as single injuries or associated with other dental injuries or injuries to the face and jaws region. They are defined as the luxation of teeth from the alveoli with complete rupture of periodontal fibres, or with one part attached to the rootcementum and the other to the alveolar bone, thus compromising the dental pulp, root cementum,and alveolar bone. The high prevalence and numerous negative consequences on the stomatognathic systems they have suggest permanent tooth avulsions should be regarded as an important public health problem. The aim: is to point out the therapeutic possibilities of permanent tooth avulsion that can ensure their longer survival in the oral cavity. Conclusion: The treatment strategy for avulsed permanent teeth is always based on limiting root canal infection and periradicular inflammation, shifting the balance from unfavourable (replacement resorption) to favourable (periodontal) healing. The success of therapy and periodontal healing depend on the duration and conditions of extraoral tooth preservation, the degree of damage to the periodontal ligament, and the condition of the pulp.

Cardiac implantable electronic devices (CIEDs) can be lifesaving but complications associated with CIEDs can lead to significant morbidity and mortality. Effective techniques to remove these devices are critical to reducing complications and improving quality of life. Percutaneous extraction techniques are effective for removing the majority of CIEDs but surgical lead extraction is still required in certain situations. Surgical lead extraction volumes are generally low at most centers but familiarity with the techniques and principles is important for maintaining a comprehensive lead management program. This review discusses indications and techniques for surgical lead extraction and considerations for device reimplantation., Competing Interests: Disclosure A.J. Lee does not have any financial disclosures. J. Bashir has consulting fees and research grants from Boston Scientific, Cook Medical and Edwards Lifesciences., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Background  Replantation is the ideal treatment in traumatic scalp defects to provide immediate coverage with restoration of hair-bearing skin. However, data are limited to case reports and small case series. Comprehensive analysis of techniques and outcomes is not available. Our aim was to systematically analyze the available literature to better understand management and postoperative outcomes of patients undergoing scalp replantation. Methods  A systematic review of the PubMed, Cochrane, and EBSCO databases was performed in October 2019. Search terms included "replantation," "replant," "revascularized," "revascularization," "avulsion," and "scalp." Only papers reporting microvascular replantation of completely avulsed scalps, including case reports, were included. Review articles, non-English language articles, articles discussing nonreplant coverage, incomplete scalp avulsions, and articles discussing delayed scalp replantation were excluded. Data extracted included demographics, percent of scalp affected, mechanism, operative technique, and postoperative outcomes. Statistical analysis was performed using Mann–Whitney U tests, Kruskal–Wallis, and chi-squared tests. Results  From a total of 704 initial results, 61 studies were included for analysis comprising 149 scalps. Complete survival was achieved in 54.7%, partial survival in 38.9%, and failure in 6.7%. Total ischemia time greater than 12 hours was associated with complete replant failure. Arterial anastomoses appeared to protect against complete loss. The number of venous repairs, proportion of venous-to-arterial repairs, use of vein grafts, thromboprophylaxis, or intraoperative complications did not affect outcomes. Patients required significant volumes of blood products, which was associated with partial success. Salvage rate after unplanned return to the operating room was 60.0%. Normal hair growth was achieved in all surviving native scalp tissue. Conclusion  Scalp replantations, while technically challenging, are the ideal treatment for scalp avulsions. Fortunately, these have high rates of success. And as a focal point of a patient's appearance, this is invaluable in restoration of a sense of normalcy. [ABSTRACT FROM AUTHOR]

Objective: Management of emergency care Background: Upper limb replantation has become an almost routine procedure, with digital and hand reattachments being the most commonly performed. These remain challenging procedures to reconstructive surgeons, especially when there is trauma to the detached limb. Injury to the overlying skin and soft tissue can lead to tissue necrosis, sepsis, and loss of the replanted limb. The use of skin grafts as well as a wide variety of muscular, musculo-cutaneous, fascio-cutaneous flaps, and free-transfer grafts has significantly diminished limb loss. We report on the use of a delayed fascio-cutaneous, pedicled groin flap to cover a defect on the dorsum of a hand replanted 6 weeks earlier. Case Report: A right-hand-dominant male laborer had his left hand completely severed by a sharpened machete. This was surgically replanted with limb salvage but there was an area of denuded tissue on the dorsum, devoid of epidermal coverage. A fascio-cutaneous, pedicled rotational flap arising from the left groin was used as definitive cover for the defect. This flap augmented the replantation process by producing a functional and visually acceptable replant, allowing the patient to undergo rehabilitation and eventually return to the workforce. Conclusions: The fascio-cutaneous, pedicled, rotational groin flap is a thin, pliable, but robust flap which covered the defect created by the initial injury with a protective tissue layer. It allowed free movement of the extensor tendons by creating a smooth surface over which they could easily glide with retention of near-normal, functional hand movement. [ABSTRACT FROM AUTHOR]

The management of mangled upper extremity is very challenging because the anatomical complexity of the region, the large number of possible involved anatomical elements, and the necessity of obtaining a good functionality. The impressive development of microsurgical techniques in the last decades contributed a lot to the salvage of several extreme injuries with mangled extremities considered untreatable in the past. Such injuries can nowadays be successfully managed by means of replantation/revascularization or complex reconstruction by using simple or complex microsurgical flaps. The more important steps in managing a mangled upper extremity are the decision making, the moment of reconstruction, the debridement, and the reconstruction by using customized methods. The decision regarding extremity salvage or amputation has to be individualized taking into account general and local factors. These factors influence the absolute or relative indication, but the final decision is up to the experience of every single surgical team. The timing of reconstruction is still a large debated subject, but it seems that the reconstruction as soon as possible is in the advantage of obtaining a much better functional recovery. The debridement should be very carefully performed in the attempt to preserve all the essential anatomical elements able to allow the obtaining of enough functionality. Most of these lesions are accompanied by simple or complex tissue defects. The coverage of these defects needs customized simple or composite flaps used both as free and local/regional microsurgical flaps. Based on the experience regarding the strategy and management of the mangled upper extremity in two European hand trauma centers, we conclude that the keystone in savaging this kind of lesions is represented by a very carefully assessment of the patient and lesion, an enough aggressive debridement, and an as soon as possible reconstruction. [ABSTRACT FROM AUTHOR]

Reconstructive microsurgery has been an essential aspect of orthopaedic surgery and extremity reconstruction since the introduction of the operating microscope in the mid-20th century. The reconstructive ladder ranges from simple healing by secondary intention to complex procedures such as free tissue transfer and vascularized composite allotransplantation. As orthopaedic surgery has evolved over the past 60 years, so too have the reconstructive microsurgical skills that are often needed to address common orthopaedic surgery problems. In this article, we will discuss a variety of complex orthopaedic surgery scenarios ranging from trauma to infection to tumor resection as well as the spectrum of microsurgical solutions that can aid in their management. [ABSTRACT FROM AUTHOR]