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BACKGROUND: Bite injuries, particularly those involving the hands, present a significant medico-legal challenge, often leading to complications and frequent emergency department visits. Dog and cat bites, especially among children, are major contributors to infections due to the complex anatomy of the hand, which predisposes it to severe infections even from minor bites. Capnocytophaga canimorsus, found in the oral cavity of dogs and cats, is particularly concerning due to its potential to cause severe infections. Prompt and appropriate treatment is essential to mitigate these risks. Managing such injuries poses significant challenges, necessitating clear guidelines for reporting and safety measures. This article highlights the urgent need for additional research, support, and education, particularly focusing on children, along with the development of international guidelines to improve outcomes for patients. CASE REPORT: A case study of a sixteen-year-old girl who had her left forearm amputated due to a rottweiler bite is presented. Despite initial attempts at replantation, complications led to the decision for amputation. CONCLUSIONS: This case underscores the challenges in managing severe dog bite injuries, emphasizing the importance of prompt assessment, thorough debridement, and proper wound management to minimize complications. Additionally, psychological evaluation and treatment are crucial for patients and parents following such traumatic events. From a medical standpoint, this case highlights the importance of monitoring inflammatory markers, appropriate surgical priorities, and the need for psychological support. Prevention of dog bites is crucial, requiring increased awareness among public authorities and dog owners. Clear guidelines for reporting dog bites are essential, but further research is needed to improve their comprehensiveness and effectiveness. [ABSTRACT FROM AUTHOR]

This study was performed to explore the treatment of the injury caused by traumatic limb amputation.From October 2002 to October 2021, 30 cases were enrolled in the present study. The reasons for injury were as follows: 8 cases with single hydraulic column crush injury, 12 cases with gear and wire rope stranding, 6 cases with belt avulsion injury, and 4 cases with carbon block smash injury. The present study application of a free or small saphenous vein bypass to reconstruct the injured artery and vein according to the concept of the angiosome model. The defective vessels were bridged with the axial vessels of a flow-through flap, such as a medial calf flap or anterolateral femoral flap, to construct an additional blood supply and drainage vein for the severed limb. The clinical data of 30 cases with traumatic limb amputation of the lower leg and ankle were retrospectively analyzed.In all 30 cases of traumatic limb amputation, the replantation via the adoption of a flow-through flap was successful, and 85.6% of the patients remained in good postoperative condition. There were no symptoms of ischemia in the marginal segment after blood supply reconstruction of the transected limb by axial vascular bridging within the flap.Via the adoption of microsurgical techniques, the blood supply to the transected limb can be reconstructed by bridging the defective vessels with the adoption of the axial vessels of the flow-through flap is a feasible and advanced treatment option. [ABSTRACT FROM AUTHOR]

Abstract The number of amputated finger replantation has declined in the USA and Germany in recent years; however, there have been no reports on recent trends in Japan. We examined the current practices, attempts, and success factors of digit replantation in Japan. We hypothesized that the rates of digit replantation and success rates were consistently standardized in Japan. The diagnosis procedure combination database was used to analyze 14004 cases from April 2014 to March 2020, excluding multiple-digit amputations, thus focusing on 13484 patients. We evaluated replantation success rates and identified factors influencing replantation decisions using multiple logistic regression analysis. The key findings included a higher frequency of replantation in thumb cases and surgeries during overtime hours, on Sundays, and in educational institutions. Success rates were notably higher for thumb replantations and patients under 20 years of age. Patients over 65 years of age treated with urokinase showed higher failure rates, unrelated to regional or hospital case volumes. The number of amputated digit replantation surgeries in Japan was high during overtime hours, on Sundays, and in educational institutions. Region, hospital type, and hospital case volume were not associated with a low success rate across Japan.

Background Interposition microvascular grafting may be required to bridge arterial defects during digital replantation or revascularization and has traditionally been performed utilizing a venous autograft. Arterial interposition grafting has been shown to be superior in maintaining patency in large vessel surgery; there are case reports of its use in microsurgery. Methods Six fellowship-trained hand and microsurgeons performed arterial and venous interposition grafts on the femoral arteries of 40 Wistar rats. After sectioning one femoral artery a segment of the contralateral femoral artery or vein was obtained. The time was recorded per graft and patency tested 10 minutes following grafting by an independent assessor. Each surgeon also completed a questionnaire detailing regular microsurgical volume, technical ease, and conceptual preference for either graft. Results Time for arterial interposition (median time 51.7 minutes) was longer than venous grafting (median time 45.9 minutes, p = 0.075). Arterial grafts were more likely to be patent or questionably patent (odds ratio [OR] = 6.77, p = 0.031). All surgeons found arterial interposition grafting technically easier and preferred it conceptually. Improvements were noted in patency rates (OR = 11.29, p = 0.018) and avoidance of anastomotic leak (OR = 0.19, p = 0.029) when surgeons performed moderate levels or greater of microsurgery within their regular practice. Conclusion Greater immediate patency was noted with arterial interposition grafting in a rodent model when compared to venous grafting, although procedural time was greater. All surgeons found arterial grafting technically easier. Arterial microvascular grafting may be useful in the setting of digital replantation or revascularization with an arterial defect. [ABSTRACT FROM AUTHOR]

BACKGROUND: This controlled experimental study aimed to compare ectopic replantation with other replantation techniques in a rat model of crush amputations. It also assessed the impact of different replantation methods on the viability of amputates. METHODS: Forty male Wistar albino rats were divided into four groups. Groin flaps served as the amputation model. Group 1 underwent guillotine-style amputation followed by orthotopic replantation, Group 2 experienced crush-type amputation and orthotopic replantation, Group 3 had crush-type amputation and orthotopic replantation with a vein graft, and Group 4 underwent crush-type amputation followed by ectopic replantation. Flap viability and perfusion rates were assessed on day 3 using an infrared perfusion assessment system. The ratio of viable area to total flap area and thrombus formation in the pedicle vessels were evaluated on day 7. RESULTS: Infrared evaluations on day 3 post-replantation revealed flap perfusion percentages of 73.5% in Group 1, 11.1% in Group 2, 65% in Group 3, and 64.1% in Group 4. Statistical analysis indicated that Group 1 exhibited the highest perfusion rates, while Group 2 showed the lowest. No differences were observed between Groups 3 and 4. On the seventh day, the average surviving flap areas were found to be 74.6% in Group 1, 2.5% in Group 2, 64.5% in Group 3, and 64% in Group 4. Statistically, Group 1 exhibited the best outcomes, while Group 2 had the poorest, with no differences between Groups 3 and 4. Additionally, thrombus formation was observed in the vessels of two animals in Group 1, nine in Group 2, and three each in Groups 3 and 4. Significant statistical differences were noted among the groups. CONCLUSION: The results indicate that ectopic replantation and replantation with a vein graft are equally effective. The preferred method for crush-type replantations may depend on the patient’s and the amputated limb’s conditions. In crush-type amputations, we recommend vein graft repair if the patient’s overall condition supports replantation and if crushed segments can be debrided without excessive shortening of the amputated part. If these conditions are not met, temporary ectopic replantation is advised to preserve the amputated limb [ABSTRACT FROM AUTHOR]

The number of amputated finger replantation has declined in the USA and Germany in recent years; however, there have been no reports on recent trends in Japan. We examined the current practices, attempts, and success factors of digit replantation in Japan. We hypothesized that the rates of digit replantation and success rates were consistently standardized in Japan. The diagnosis procedure combination database was used to analyze 14004 cases from April 2014 to March 2020, excluding multiple-digit amputations, thus focusing on 13484 patients. We evaluated replantation success rates and identified factors influencing replantation decisions using multiple logistic regression analysis. The key findings included a higher frequency of replantation in thumb cases and surgeries during overtime hours, on Sundays, and in educational institutions. Success rates were notably higher for thumb replantations and patients under 20 years of age. Patients over 65 years of age treated with urokinase showed higher failure rates, unrelated to regional or hospital case volumes. The number of amputated digit replantation surgeries in Japan was high during overtime hours, on Sundays, and in educational institutions. Region, hospital type, and hospital case volume were not associated with a low success rate across Japan. [ABSTRACT FROM AUTHOR]

Scalp avulsion is a devastating injury. The best possible procedure is replantation. Several successful scalp replantations with anastomoses of several vessels in large defects have been reported. In this report, we present a case of replantation of a large scalp avulsion using revascularizing with only one artery and vein. Despite the initial signs of flap congestion, we could predict the survival of the replanted scalp and terminate the procedure after detecting good perfusion and washout with indocyanine green fluorescence imaging. The procedure was successful following the patient's recovery of sensory and sweating functions without complications such as flap necrosis or infection. Several important factors for successful scalp replantation with positive esthetic and functional outcomes were considered. [ABSTRACT FROM AUTHOR]

Background/Aim: There are few long‐term clinical follow‐up studies on human teeth replanted immediately or after storage in a suitable storage medium prior to replantation. This study aimed to assess the risk of ankylosis in avulsed human teeth replanted immediately or after storage in physiological media for a short time. Material: Data from 116 patients with 145 replanted avulsed permanent teeth were selected from a comprehensive dental trauma database in Copenhagen University Hospital. The following teeth were selected: Group 1 comprised 36 teeth replanted immediately (dry time <6 min; wet time <6 min). Group 2 comprised 61 teeth replanted after physiologic storage media (saliva and saline) (dry time <6 min; wet time >5 min; wet time ranged from 7 to 170 min, and mean wet time was 59 min). Group 3 (control) included 48 teeth replanted after dry storage (dry time > 60 min). Method: Clinical and radiographic registrations were carried out according to a standardized protocol; follow‐up ranged from 7 months to 23 years. Ankylosis was diagnosed by percussion test and radiographs and related to the conditions prior to replantation and stage of root development. Results: The overall risk of ankylosis was 17.2% [95% CI: 4.61; 29.79] for immediately replanted teeth, 55.3% [95% CI: 42.54; 68.00] for teeth stored in physiologic media before replantation, and 85.7% [95% CI: 75.70; 95.73] for teeth stored dry more than 1 h. Mature teeth showed a significantly higher risk of ankylosis than immature teeth. Conclusion: This clinical long‐term study has verified earlier experimental studies showing that immediate reimplantation has the lowest risk of ankylosis. Physiologic storage media are good alternatives that also reduce the risk of ankylosis compared to dry storage, where ankylosis is more likely although not always seen. Mature teeth are significantly more likely to develop ankylosis. [ABSTRACT FROM AUTHOR]

There is a lack of data regarding the baseline hemodynamic blood flow parameters of the wrist and digits. Therefore, we aimed to quantify the digital and radial artery blood flow parameters using ultrasound and assess the influence of patient characteristics on hemodynamics. We analyzed ultrasonographic data from 25 patients (50 hands) between October 2019 and December 2021. Variables of interest included dimensions of the radial artery and index finger (IF) ulnar and radial digital arteries at the palmodigital crease and their corresponding flow parameters. We compared variables among men and women and patients with and without diabetes using Wilcoxon Rank Sum test. Our cohort consisted of 18 women (36 hands) and three participants with diabetes (six hands). The mean diameter of the IF radial digital artery was 7 mm, and that of the ulnar digital artery was 10 mm. The average peak systolic velocity for the radial digital artery was 21.31 cm/sec, and for the ulnar digital artery, it was 30.03 cm/sec. Comparing men and women, the only significant difference found was in the time-averaged mean velocity for the ulnar digital artery (men:5.66 cm/sec vs. women:9.68 cm/sec, P = 0.02) and volume of flow for the ulnar digital artery (men:10.87cc/min vs. women:18.58cc/min, P = 0.03). We found no differences in blood flow parameters comparing participants with and without diabetes. These data provide a baseline measurement of digital flow hemodynamics that can be used in future studies to model vascular flow after replantation. [ABSTRACT FROM AUTHOR]

Distal fingertip replantation is associated with being a technically demanding procedure and dubious outcomes, although it is now performed more frequently across the world. However, the technique and outcomes remain controversial with disagreement among replantation surgeons due to lack of consensus about the indications, intraoperative strategy and postoperative regimes. In this article, we asked six experienced hand surgeons several pertinent questions that every replantation surgeon performing distal fingertip replantation would face in their clinical practice. The article summarizes their responses, which might provide valuable insight to every replantation surgeon in different parts of their career while managing these injuries. [ABSTRACT FROM AUTHOR]

ABSTRACT Objetive: This article presents a retrospective cohort study analyzing patients from IOT-FMUSP who underwent replantation or revision amputation procedures for traumatic thumb amputation between 2013 and 2020. Methods: The study included 40 patients in the replanted group and 41 patients in the amputed group. The patients were divided according to the level of amputation and their medical records were analyzed. Results: A total of 81 patients with digital amputation were analyzed, consisting of 79 males and 2 females, with mean ages of 43 and 49 for the amputed and replanted groups, respectively. According to the Biemer classification, 28.4% had proximal amputation, while 71.6% had distal amputation. The most common occupation was bricklayer (19.75%), and 80.24% were manual workers. Of the patients, 65% returned to their previous work, with 77.77% of them having amputation on their non-dominant hand, mostly caused by circular saw accidents (77.77%). The replantation success rate was 78%, with an average ischemia time of 9 hours and door-to-room time of 2 hours. Conclusion: the study findings revealed that traumatic thumb amputation predominantly affects working-age males with a low education level and the success rate of replantation was high in this ischemia time and door-to-room conditions. Level of Evidence II, Retrospective study.

Upper extremity amputations represent a prime opportunity to restore function through replantation. There are a variety of options that treating surgeons use to protect neurovascular repairs and restore function including Kirschner wire fixation, external fixation, wrist arthrodesis, and proximal row carpectomy. Additionally, the dorsal spanning plate may be a valuable tool for protecting neurovascular repairs. Compared to temporary immobilization with Kirschner wire fixation, which has previously been described in conjunction with upper extremity replantation, dorsal spanning plates can be left in place for longer durations with a lower risk of loosening and loss of fixation and for preventing postoperative sabotage or repeat amputation of the replant by the patient. In this article, we describe a unique case of a patient with acute psychiatric illness that presented with a self-inflicted amputation through the radiocarpal joint and was initially treated with emergent replantation and application of a dorsal spanning plate to protect the neurovascular repair from patient sabotage and allow for early rehabilitation. We found the dorsal spanning plate to be an effective option in this complex clinical scenario. This case illustrates the utility of the dorsal spanning plate in protecting complex neurovascular repairs in the setting of severe skeletal and psychiatric instability.

Ricardo Cortes, Ramazi O Datiashvili Department of Surgery, Division of Plastic Surgery, Rutgers New Jersey Medical School, Newark, New JerseyCorrespondence: Ricardo Cortes, Tel +8059106232, Email RC1160@njms.rutgers.eduAbstract: The thumb is regarded as the most important digit of the hand, accounting for approximately 40% of the entire function of the hand, loss of a functional thumb leads to loss of key functions and patient autonomy. When the nature of the injury and the amputated part allow it, replantation is the standard of care. However, in cases of tip injury, where the amputated tissue is destroyed or otherwise rendered unusable, other reconstructive methods are used. It is imperative to maintain as much function and sensation as possible while restoring as much lost function and sensation as possible. This includes preservation of the interphalangeal (IP) joint, achieving good soft tissue coverage and restoring motor and sensory functions. With a variety of techniques described in the literature, thumb reconstruction proves to be a formidable task. Moreover, the technique selected must minimized complications associated with reconstruction such as hypersensitivity, contracture deformities, poor aesthetics, limited range of motion and insufficient coverage. We review and summarize the techniques of revision amputation, Moberg advancement flap, FDMA flaps, free tissue transfer from the great toe and non-operative management. We include case reports that highlight the benefits and limitations of some of these techniques.Keywords: thumb reconstruction, replantation, amputation, thumb flaps

Abstract Background The inactivation and replantation of autologous tumor bones are important surgical methods for limb salvage in patients with malignancies. Currently, there are few reports on the inactivation and replantation of the knee joint. In this study, we aimed to evaluate the feasibility of our surgical approach. Methods This is a retrospective case series study. We retrospectively collected the clinical data of patients with sarcoma treated with knee joint inactivation and replantation and analyzed the efficacy of this surgical method. The bone healing and complications in these patients after inactivated autograft replantation were assessed. Results This study included 16 patients. Fifteen patients had osteosarcoma, and one had Ewing's sarcoma. The average length of the inactivated bone is 20.2 cm (range 13.5–25.3 cm). All the patients underwent internal plate fixation. The average follow-up duration was 30 months (range 8–60 months). Before the data deadline of this study, eight (50%) patients were still alive, and eight (50%) died of sarcoma metastasis. Eight (50%) patients achieved bone healing at the diaphysis site of the inactivated tumor bone, with an average bone healing time of 21.9 months (range, 12–36 months). Five (31%) patients died due to metastases and did not achieve bone healing. Two (12.5%) patients did not achieve bone healing because of infection, and one (6.3%) patient underwent amputation due to tumor recurrence. Ten (62.5%) patients experienced fractures around the joint ends of the inactivated replanted bone, and eight of these ten patients were combined with joint dislocation. Conclusion The incidence of joint deformities after the knee-joint inactivation and replantation is extremely high and is not recommended for use.

Tamai zone 4 replantation, defined as the replantation at a level proximal to the flexor digitorum superficialis' insertion and distal to where the common digital artery branches into the proper digital artery, has poor functional results because making orthosis and rehabilitation protocols that protect the bone and the flexor and extensor tendons simultaneously difficult. Two cases of Tamai zone 4 replantation are presented: one case of an index finger replantation at the proximal phalanx and a case of ring finger replantation at the proximal interphalangeal joint. The author did not repair the flexor tendon intentionally in the primary replantation and performed two-stage flexor tendon reconstruction later. The total active motions (TAMs) at the last follow-up were 215 and 180 degrees, respectively, with the latter distal interphalangeal joint being an arthrodesis. Both cases had no extension lag in the proximal interphalangeal joint. These results were much better than those in previous reports, in which the mean TAM was 133 degrees or less. The good results appeared to be mainly due to the reasonable and clear postoperative rehabilitation protocols made by the proposed procedure. This procedure may be useful for obtaining reproducible functional results even in Tamai zone 4 replantation.

This report presents the therapeutic approach and results of a case of impacted undeveloped double teeth using 3D simulation in a school-age child. A 10-year-old girl was referred to hospital for the evaluation and treatment of fully impacted premolar double teeth in the left maxillary area. After evaluation, the double teeth were surgically removed, hemisected, and replanted after modification. For accurate surgery, replicas were made of the double teeth using CBCT and a 3D printer, and several mock surgeries were performed. Although remarkable signs for clinical and radiologic pathology were not found at the 5-month follow-up, short root with infraocclusion was found at the 30-month follow-up. This treatment widened the treatment spectrum with modern diagnostic approaches and preparation in large double teeth in children. [ABSTRACT FROM AUTHOR]

Background: The frozen inactivation of autologous tumor bones using liquid nitrogen is an important surgical method for limb salvage in patients with sarcoma. At present, there are few research reports related to frozen inactivated autograft replantation. Methods: In this study, we retrospectively collected the clinical data of patients with bone and soft tissue sarcoma treated with liquid nitrogen-frozen inactivated tumor bone replantation, and analyzed the safety and efficacy of this surgical method. The healing status of the frozen inactivated autografts was evaluated using the International Society of Limb Salvage (ISOLS) scoring system. Functional status of patients was assessed using the Musculoskeletal Tumor Society (MSTS) scale. Results: This study included 43 patients. The average length of the bone defect after tumor resection is 16.9 cm (range 6.3--35.3 cm). Patients with autograft not including the knee joint surface had significantly better healing outcomes (ISOLS scores) (80.6% ± 15% vs 28.2% ± 4.9%, P<0.001) and limb function (MSTS score) (87% ± 11.6% vs 27.2% ± 4.4%, P<0.001) than patients with autografts including the knee joint surface. The healing time of the end of inactivated autografts near the metaphyseal was significantly shorter than that of the end far away from the metaphyseal (9.8 ± 6.3 months vs 14.9 ± 6.3 months, P=0.0149). One patient had local recurrence, one had an autograft infection, five (all of whom had an autograft including the knee joint surface) had joint deformities, and seven had bone non-union. Conclusion: Frozen inactivated autologous tumor bone replantation is safe and results in good bone healing. But this method is not suitable for patients with autograft involving the knee joint surface. [ABSTRACT FROM AUTHOR]

Functionality after upper limb replantation is a decisive factor when considering the success of the intervention. Therefore, its evaluation is fundamental. The aim of this article was to conduct a systematic review of upper limb functions after replantation or reimplantation, seeking to identify reported functional outcomes as well as the level and mechanism of injury. To achieve this objective, a literature search was conducted in PubMed, ScienceDirect, Cochrane and Web of Science. Studies from the last 10 years which included patients with upper limb replantation and reported their functional outcomes were included. Out of 523 articles, 12 studies (n = 607) were finally included. DASH and CISS were the most commonly used assessments to report functional outcomes. In conclusion, functional outcomes after replantation are assessed using widely varying scales; therefore, due to this methodological variability, it is difficult to compare functional success between studies and further studies on functionality are needed to provide new data. [ABSTRACT FROM AUTHOR]

Purpose: To describe our technique, namely, combined distal phalangeal fixation and nail bed repair with a V-Y volar advancement flap for Allen type III fingertip amputation. Methods: The clinical data of 16 patients (18 fingers) with Allen type III fingertip amputation who underwent this procedure were retrospectively studied. Distal phalangeal fixation and nail bed repair were performed first to transform the injury into a pulp defect, and then the volar V‒Y flap was applied to cover the defect. Postoperatively, humectant was applied to moisten the nail but no lamp heating was applied. The main indicators were patient self-reported appearance and daily use, static two-point discrimination, range of distal interphalangeal joint motion (range of DIPJ motion), complications and the Chinese Medical Association upper limb function evaluation trial standard for severed fingers (CMA evaluation). Results: The average follow-up time was 14.3 months. All 18 fingertips survived. One patient underwent a secondary surgery due to infection resulting in exposure of the bone of the fingertip. One patient developed a hooked nail. The appearance and daily use of the fingertip were satisfactory or acceptable for all the patients except for those who experienced the above two complications. After one year, the mean static two-point discrimination was 3.8 mm (range 2.5–4.6 mm). The range of DIPJ motion of the affected fingers was 90.7% of that of the unaffected side. According to the CMA evaluation, 13, 3 and 2 fingers showed excellent, good and average results, respectively. Conclusions: The combination of distal phalangeal fixation and nail bed suturing with a V-Y volar advancement flap is worthy of clinical application for Allen type III fingertip amputation. The technique is simple and straightforward. Level of evidence: Level III, Therapeutic study. [ABSTRACT FROM AUTHOR]

Background: The inactivation and replantation of autologous tumor bones are important surgical methods for limb salvage in patients with malignancies. Currently, there are few reports on the inactivation and replantation of the knee joint. In this study, we aimed to evaluate the feasibility of our surgical approach. Methods: This is a retrospective case series study. We retrospectively collected the clinical data of patients with sarcoma treated with knee joint inactivation and replantation and analyzed the efficacy of this surgical method. The bone healing and complications in these patients after inactivated autograft replantation were assessed. Results: This study included 16 patients. Fifteen patients had osteosarcoma, and one had Ewing's sarcoma. The average length of the inactivated bone is 20.2 cm (range 13.5–25.3 cm). All the patients underwent internal plate fixation. The average follow-up duration was 30 months (range 8–60 months). Before the data deadline of this study, eight (50%) patients were still alive, and eight (50%) died of sarcoma metastasis. Eight (50%) patients achieved bone healing at the diaphysis site of the inactivated tumor bone, with an average bone healing time of 21.9 months (range, 12–36 months). Five (31%) patients died due to metastases and did not achieve bone healing. Two (12.5%) patients did not achieve bone healing because of infection, and one (6.3%) patient underwent amputation due to tumor recurrence. Ten (62.5%) patients experienced fractures around the joint ends of the inactivated replanted bone, and eight of these ten patients were combined with joint dislocation. Conclusion: The incidence of joint deformities after the knee-joint inactivation and replantation is extremely high and is not recommended for use. [ABSTRACT FROM AUTHOR]

Objective: Management of emergency care Background: Circumcision is commonly performed in males, especially in Jewish and Muslim cultures, and is considered a safe surgical procedure with a low complication rate. Major complications, such as partial and total penile amputation, can occur, but those are rare complications. However, high replantation success rates have been reported and reviewed. Case Report: We describe the case of an 8-year-old boy who experienced total penile amputation during ritual circumcision performed by a layperson outside the hospital setting. Microsurgical penile replantation was performed after an ischemic period of 16 hours 43 minutes, with successful outcomes and without any major complications. In our technique, we repaired both dorsal and deep cavernosal vessels. At 1-year postoperative period, the results of two-point discrimination test were 4 mm, 7 mm, and 7 mm on the dorsal part, ventral part, and glans, respectively. After a follow-up period of 4 years, there were no late complications such as penile deformity, urethral fistula, urethral stenosis, absence of penile sensation, or erectile dysfunction. The results of two-point discrimination test were 3 mm, 5 mm, and 5 mm on the dorsal part, ventral part, and glans, respectively. The patient also experienced good penile sensation, morning erection, satisfaction with the cosmetic outcome, and a peak urine flow rate of 21 mL/s with a consistently strong void stream and a low postvoid residual urine volume of 20 mL. Conclusions: Our experience suggests that a short ischemic time, prompt surgical correction, microscopic technique of replantation, and intensive postoperative care can result in good functional outcomes. [ABSTRACT FROM AUTHOR]

Background: The absence of valid vessels for the anastomosis constitutes a contraindication to replantation, but the need for arterial vessels in good condition has recently been questioned and some authors have proposed the arterialization of the veins with promising results. However, this method is not routine in replantation and it is unclear what conditions can establish venous congestion and loss of the replanted segment. Case Report: We detail a case where indocyanine green aids in evaluating arterialization of a vein during thumb replantation in a 40-year-old smoker following a crush injury. Multiple attempts to anastomose the princeps pollicis and its collateral vessel failed due to a thrombus formation, leaving the finger non-perfused despite urokinase treatment. To confirm the absence of reperfusion, we administered 0.3 mg/kg of indocyanine green through an upper limb peripheral vein. Observing no reperfusion, we located a suitable radial dorsal vein and performed an arteriovenous anastomosis at the proximal phalanx level. Indocyanine Green Angiography (IGA) revealed a slightly delayed reperfusion but a effective venous outflow. We did not consider it necessary to perform additional venous anastomoses other than the single dorsal radial venous anastomosis. Conclusions: This single case report shows the potential of indocyanine green as a valid aid to evaluate the perfusion of the replantation and also any early venous congestion, being able to modify the operative plan accordingly. [ABSTRACT FROM AUTHOR]

Tamai zone 4 replantation, defined as the replantation at a level proximal to the flexor digitorum superficialis' insertion and distal to where the common digital artery branches into the proper digital artery, has poor functional results because making orthosis and rehabilitation protocols that protect the bone and the flexor and extensor tendons simultaneously difficult. Two cases of Tamai zone 4 replantation are presented: one case of an index finger replantation at the proximal phalanx and a case of ring finger replantation at the proximal interphalangeal joint. The author did not repair the flexor tendon intentionally in the primary replantation and performed two-stage flexor tendon reconstruction later. The total active motions (TAMs) at the last follow-up were 215 and 180 degrees, respectively, with the latter distal interphalangeal joint being an arthrodesis. Both cases had no extension lag in the proximal interphalangeal joint. These results were much better than those in previous reports, in which the mean TAM was 133 degrees or less. The good results appeared to be mainly due to the reasonable and clear postoperative rehabilitation protocols made by the proposed procedure. This procedure may be useful for obtaining reproducible functional results even in Tamai zone 4 replantation. [ABSTRACT FROM AUTHOR]

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Aim: The objective of this review is to conduct a thorough systematic literature search and evaluate the risks and benefits of replanting avulsed primary teeth, which will aid clinicians in proper decision-making. Materials and Methods: In this review, a systematic search of five electronic databases (Web of Science, PubMed-MEDLINE, Scopus, Ovid SP, and Embase) was independently conducted by two reviewers. After following the eligibility criteria, the collated data was uploaded to Zotero and Excel Workbooks. Any disagreement was resolved through adjudication by the third reviewer. For case reports and case series, the Joanna Briggs Institute checklist was used to assess quality. Results: Following the application of the eligibility criteria, 15 papers were deemed eligible for final analysis, and full texts were acquired. Among 26 replanted teeth, adverse effects were seen in 19 primary teeth and 7 permanent successors. The primary teeth that were replanted had the following unfavorable effects: mobility, resorption of the bone, fistula formation, radicular cyst formation, crown discoloration, and pulp necrosis. Similarly, the adverse effects on the permanent successors were impaction, enamel hypoplasia, dilacerations, and infra-occlusion. Conclusions: Following the biological principles, such as the condition of the tooth, the time elapsed since avulsion and age of the child, and replantation of avulsed primary teeth, can be a feasible treatment option. However, the feasibility is case-dependent and cannot be generalized because of the paucity of high-quality research with sufficient sample sizes and long follow-up periods. [ABSTRACT FROM AUTHOR]

Objective: Management of emergency care Background: Circumcision is commonly performed in males, especially in Jewish and Muslim cultures, and is considered a safe surgical procedure with a low complication rate. Major complications, such as partial and total penile amputation, can occur, but those are rare complications. However, high replantation success rates have been reported and reviewed. Case Report: We describe the case of an 8-year-old boy who experienced total penile amputation during ritual circumcision performed by a layperson outside the hospital setting. Microsurgical penile replantation was performed after an ischemic period of 16 hours 43 minutes, with successful outcomes and without any major complications. In our technique, we repaired both dorsal and deep cavernosal vessels. At 1-year postoperative period, the results of two-point discrimination test were 4 mm, 7 mm, and 7 mm on the dorsal part, ventral part, and glans, respectively. After a follow-up period of 4 years, there were no late complications such as penile deformity, urethral fistula, urethral stenosis, absence of penile sensation, or erectile dysfunction. The results of two-point discrimination test were 3 mm, 5 mm, and 5 mm on the dorsal part, ventral part, and glans, respectively. The patient also experienced good penile sensation, morning erection, satisfaction with the cosmetic outcome, and a peak urine flow rate of 21 mL/s with a consistently strong void stream and a low postvoid residual urine volume of 20 mL. Conclusions: Our experience suggests that a short ischemic time, prompt surgical correction, microscopic technique of replantation, and intensive postoperative care can result in good functional outcomes. [ABSTRACT FROM AUTHOR]

The novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), causing COVID-19, has spread across the globe. To limit the spread of COVID-19, the Italian government imposed various restrictions (lockdowns). These restrictions had an impact on the flow of patients accessing hospital care. Our aim in this study was to analyze the impact of lockdowns on the epidemiology of patients suffering from hand trauma. Our work analyzed the variation in the number and characteristics of hand trauma patients during the lockdown and half-lockdowns in 2020 compared to the same periods in the previous and subsequent years. In 2020, during the lockdown period, 107 patients were treated by our department for hand trauma, amounting to a 2% increase compared to the average number of patients treated in the pre-pandemic period. In 2020, during the half-lockdown period, 158 patients were treated, amounting to a 6.8% increase in comparison to the pre-pandemic period. During the lockdown period in Italy, the flow of patients suffering from hand trauma referred to our hub center remained stable. Given the restrictions imposed by the lockdown, we expected a consequent reduction in the number of work-related injuries, which did occur, while there was a surprising increase in the number of traffic-related injuries. The number of domestic accidents remained stable. [ABSTRACT FROM AUTHOR]

Replanting is a widely used method for improving the health and carbon sequestration capacity of degraded forests. However, its impact on soil carbon pools remains controversial. This study investigated the effects of replanting broadleaf Phoebe bournei (Hemsl.) Yang in a typical degraded fir forest. Soil carbon content, nutrient levels, and microbial community structure and function were measured at 0, 5, 8, and 12 years after replanting. The degraded fir forests were originally limited in nitrogen and phosphorus. Phoebe bournei replanting significantly increased soil total carbon but reduced total nitrogen and phosphorus levels, resulting in increased soil carbon:nitrogen, carbon:phosphorus, and nitrogen:phosphorus ratios. Microbial biomass carbon, nitrogen, and phosphorus were all significantly reduced, whereas microbial carbon:phosphorus and nitrogen:phosphorus ratios were enhanced. Enzyme activities related to nutrient cycling and carbon decomposition (acidic invertase, polyphenol oxidase, peroxidase, urase, nitrate reductase, and acidic phosphatase activities) were significantly lowered by replanting. Microbial richness and diversity significantly increased, and microbial community composition changed significantly due to replanting. Structural equation modeling revealed the significant role of total phosphorus in microbial biomass, microbial community composition, and enzyme activity, highlighting it as the main factor accelerating soil carbon accumulation. Network analysis identified Leifsonia, Bradyrhizobium, and Mycolicibacterium members as key microbial players in the soil carbon cycle. In summary, P. bournei replanting exacerbated soil phosphorus deficiency, leading to a decrease in soil microbial biomass and changes in community structure, reduced nutrient cycling and carbon-decomposition-related enzyme activities, less litter decomposition, and increased organic carbon accumulation. These findings demonstrate the importance of nutrient limitation in promoting soil carbon accumulation and offer new insights for soil carbon regulation strategies in forestry. [ABSTRACT FROM AUTHOR]

Objective To compare the clinical efficacy of single-port robot-assisted laparoscopic ureteral reimplantation (RALUR) versus laparoscopic ureteral reimplantation (LUR) for primary vesicoureteral reflux (VUR) in children. Methods From January 2017 to April 2022, the relevant clinical data were retrospectively reviewed for 70 VUR children. According to surgical approaches, they were assigned into two groups of robot (n=30) and laparoscopy (n=40). Two groups were compared in terms of preoperative preparation time, abdominal operative duration, intraoperative hemorrhage, hospitalization time, surgical success rate and postoperative complications. Results All procedures were successful without any conversion into open surgery. In robot group, reflux was unilateral (n=22) and bilateral (n=8). In laparoscopic group, reflux was unilateral (n=30) and bilateral (n=10). Operative duration: unilateral robotic group min was greater than unilateral laparoscopic group [(155.18±18.94) vs.(126.33±19.75) min]. The difference was statistically significant (P<0.05); Bilateral robotic group was greater than bilateral laparoscopic group [(210.50±19.25) vs.(177.10±16.61) min], The difference was statistically significant (P<0.05); Handling duration: unilateral robotic group was longer than unilateral laparoscopic group [(117.77±23.21) vs.(109.30±10.57) min]. The difference was statistically insignificant (P=0.180). No significant difference existed between bilateral robotic and bilateral laparoscopic groups [(169.50±25.48) vs.(158.50±16.67) min]; Intraoperative hemorrhage: robotic group was greater than laparoscopic group [(15.20±3.24) vs.(25.23±5.84) ml]. The difference was statistically significant (P<0.05); Duration of hospitalization: robotic group was less than laparoscopic group [6.5(6.0, 7.0) vs. 7.0(7.0, 8.0) day]. The difference was statistically significant (P<0.05); Postoperative indwelling time of Foley tube: robotic group was equal to laparoscopic group [3.0(3.0, 4.0) vs. 3.0(3.0, 4.0) day]. The difference was statistically insignificant (P=0.714). One case in robot group and 2 cases in laparoscopic group developed febrile urinary tract infection (UTI) post-operation and recovered after antibiotics treatment. Voiding cystourethrogram (VCUG) revealed unilateral reflux in robot group (n=1) and laparoscopic group (n=3). Four children received continuous antibiotic prophylaxis (CAP) for 3 months and reflux disappeared on VCUG re-examination. One case in robot group and 3 cases in laparoscopic group experienced acute postoperative urinary retention. After time of indwelling catheter was extended to 2 weeks, catheter was successfully removed without further urinary retention. Conclusion Single-port RALUR and LUR are both safe and effective for pediatric VUR. Single-port RALUR has a longer operative duration than LUR and yet less intraoperative hemorrhage and shorter hospitalization stay. Also incision of single-port RALUR is cosmetically superior and RALUR offers some value of clinical application. [ABSTRACT FROM AUTHOR]

Clinicians assessing patients with deliberate self-inflicted amputations face a problem of whether or not to replant. The objective of this study was to summarize the literature on this topic and provide recommendations regarding the acute management of patients following self-inflicted amputations in the upper extremity. Two reviewers searched four databases using the keywords "Upper extremity," "Amputation," and "Self-Inflicted." The reviewers systematically screened and collected data on publications reporting cases of self-inflicted upper-extremity amputations. The findings then were summarized in a narrative fashion. Twenty-four studies were included. Twenty-nine cases of self-inflicted upper-extremity amputations were reported. There were 25 unilateral and four bilateral extremity amputations. Amputations were most commonly at the hand/wrist (18 patients) and forearm level (6 patients). The amputations were most commonly performed with a saw (9 patients) or a knife (8 patients). Reasons for amputation included psychosis (10 cases), suicide attempt (7 cases), depression (5 cases), and body integrity identity disorder (four cases). Fifteen replantations were performed; all were successful. Reasons for not pursuing replantation were related to injury factors (ie, multilevel injury, prolonged ischemia, damaged part) rather than patient-level factors. Two patients with replantable extremities declined replantation, both of whom had body integrity identity disorder. Of the patients who underwent replantation, none expressed regret. The literature shows that patients experiencing psychosis or depression committed self-harm during an acute psychiatric decompensation, and once medically and psychiatrically stabilized, expressed satisfaction with their replanted limb. Surgeons should not consider psychiatric decompensation a contraindication to replantation and should be aware of patients with body integrity identity disorder who consciously may elect to undergo revision amputation. When presented with patients experiencing psychiatric decompensation who refuse replantation/are not competent, surgeons should seek emergency assistance from the psychiatry team to determine the best management of a self-inflicted amputation. Therapy/Prevention/Etiology/Harm V. [ABSTRACT FROM AUTHOR]

Although replantation of amputated facial segments remains challenging in reconstructive surgery, it offers excellent aesthetic and functional outcomes. From May 2004 to October 2019, 12 patients underwent replantation of amputated facial tissues by supermicrosurgery. The case details, such as the rationale for replantation, the operation method, and postoperative therapy, are described. Four cases are discussed to demonstrate the replantation of different facial parts. Facial tissue replantation was successful in all 12 patients without secondary surgery. The cases included the nose (1 patient), ears (8 patients), lips (2 patients), and one of the soft tissue segments surrounding the lower jaw. Venous congestion occurred in three patients who received a solitary arterial repair and were treated with bloodletting. All patients expressed satisfaction with the cosmetic and functional results at the final follow-up. Supermicrosurgical facial tissue replantation is a promising and effective procedure for providing patients with the best aesthetic and functional outcomes. [ABSTRACT FROM AUTHOR]

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Purpose: One of the most common causes of a failure after replantation and revascularization surgeries is 'no reflow' from proximal artery that occurs, especially following crush and avulsion injuries. In this study, we aimed to evaluate the effect of dobutamine treatment on salvage of replanted and revascularized digits. Methods: The patients with no reflow phenomenon detected in the salvage operations of replanted/revascularized digits between the years 2017 and 2020 were included in the study. Dobutamine treatment was infused at a rate of 4 µg·kg−1·min−1 intraoperatively and of 2 µg·kg−1 min−1 postoperatively. Demographic data (age, sex), digit survival rate, ischemia time, and level of injury were retrospectively analysed. Pre-infusion, intraoperative and postoperative values of cardiac index (CI), mean arterial pressure (MAP), and heart rate (HR) were recorded. Results: The phenomenon of 'no reflow' was encountered in 35 digits of 22 patients who underwent salvage surgery due to vascular compromise. The survival rate in the revascularization group was 75%, while it was 42.1% in the replanted digits. Metaphysis level of proximal phalanx was the most common localization for 'no reflow' phenomenon. The least values of CI, MAP and HR to obtain sufficient perfusion in salvaged digits were as follows: 4.2 l.min−1.m−2, 76 mm Hg, and 83 beat·min−1, respectively. Conclusions: It was demonstrated that dobutamine infusion at a rate of 4 µg·kg−1·min−1 intraoperatively and at 2 µg·kg−1·min−1 postoperatively has favorable effects on the vascular compromise derived from no reflow of proximal artery. [ABSTRACT FROM AUTHOR]

A case in a series of nine transmetacarpal replantations was presented at the combined meeting of the 7th European congress on Prevention of Hand Traumas and the 7th congress of the Bulgarian Society for Surgery of the Hand, 19-21 October 2023, Plovdiv, Bulgaria. A male patient aged 42, a heavy truck driver, was an ideal candidate for replantation. In February 2012 he sustained transmetacarpal amputation by circular saw through the proximal third of the left hand, with local crush of the tissues. During replantation enormous tissue edema appeared, caused by long ischemia time with cryopreservation of the amputated part for three hours. Restoration of the common digital nerves was postponed and performed 4 months later (Millesi procedure). Eleven years later the following outcome is registered. TAM: 110 (good), ab-adduction of 2nd and 4th fingers is restored in limited range. The effect is attributed to reinnervation of some spared interosseous muscles by the motor branch of the ulnar nerve, restored during the autoplastic of the common digital nerves. The lateral pinch between the thumb and second finger is useful. The skin sensitivity is examined by Weber static two-point discrimination test (2pdt):12 mm for 2nd and 3rd fingers, 15 mm for the 4th finger and one point for the pulps of the 5th finger and the thumb; 2pdt, carried out on the palm, in the base of the fingers, is 10 mm. The gained useful function of the hand is 50%. Original working ability is restored, but it is forbidden for the patient to work as a professional driver. He can drive his own car. In transmetacarpal replantations with level through the proximal part of the palm some interosseous muscles are preserved, and repair of the motor branch of the ulnar nerve is with favorable prognosis regarding functional recovery.

Background Extensive crush injuries to forearm pose a unique problem where replantation of uninjured hands to the forearm is not immediately possible due to difficulties in delineating tissue necrosis. Ectopic hand implantation preserves the hand and allows replanting the hand back to the forearm stump, but the tissues preserved in the stump could be inadequate to provide good hand function. In these subsets of cases, forearm reconstruction with composite flaps may offer a better chance of getting good hand function.

BackgroundModular knee arthrodesis (MKU) is a salvage treatment for recurrent periprosthetic joint infection (PJI) or PJI associated with notable bone loss. Reimplantation endoprosthetic reconstruction (REI) is an option in patients with MKU who have PJI clearance but are not satisfied with pain or functional outcomes with MKU. The purpose of this study was to evaluate the outcomes of MKU to REI conversion.MethodsThis was a single-center retrospective cohort study of 56 patients who underwent MKU to REI from 2010 to 2019. All patients were staged according to the McPherson staging system. An infecting organism was documented based on pre-MKU aspiration or intraoperative cultures at the time of MKU. Rate ratios were calculated for relevant patient factors. Rate ratios were calculated using Poisson regression with a log link.ResultsThe mean REI patient age was 67 years, most of the patients were McPherson B hosts (62.5%) with a type 2 (46.4%) or type 3 (51.8%) limb score, and all PJI were chronic. The most common infecting organisms at the time of MKU were Staphylococcus epidermidis (23.2%) and Staphylococcus aureus (23.2%, MSSA 14.3%, MRSA 8.9%). The mean time from MKU to REI was 220 days. An 8.9% REI index hospitalization complication rate and a 21.4% overall complication rate (excluding reinfection) were observed. Sixty-seven percent of the patients remained infection-free at an average follow-up of 37 months, among those there was 96.4% implant survivorship. No notable association was observed between index PJI organism or McPherson staging and REI failure secondary to PJI.DiscussionApproximately two thirds of patients who undergo conversion from MKU to REI have infection-free survival at the midterm follow-up. An index infecting organism and a McPherson host type do not seem to be markedly associated with reinfection risk. These findings help guide expectations of PJI MKU conversion to REI.

Abstract Purpose Ischemic time is a key factor in satisfactory functional results after forearm replantation. In this study, we provide a detailed description of our surgical technique, the temporary screw plate fixation technique, which aims to reduce ischemic time. Methods From June 2007 to June 2017, we performed a retrospective study of 20 patients who underwent forearm replantation. Eighteen cases involved male patients, and their mean age was 46 years. The mechanism of injury was roller injuries in 5 cases, power saw injuries in 3 cases, traffic accident in 7 cases, rope injuries in 2 cases, machinery injuries in 2 cases, and crushing injuries by rebar beam in 1 case. Results A total of 20 replantation patients survived. According to injury level, there were 3 cases of the proximal type, 11 cases of the middle type, and 6 cases of the distal type. The average time to revascularization was 331 min. The total operation time was, on average, 5.73 h. In the rest of the 18 cases, the temporary screw plate fixation technique was performed, and the average time required for bone shortening and plate fixation was 38.3 min. Conclusions To reduce ischemic time, we need a plan that progressively reduces time at each stage. Among our tips, temporary screw plate fixation can reduce the initial bone surgical operation to

Objective To improve the early management of penile amputation injury by analyzing and summarizing our microreplantation experience of 4 cases of complete penile amputation. Methods Clinical data of 4 patients with complete penile amputation admitted to our hospital from March 2018 to October 2022 were collected, and their related clinical features, microsurgical procedures, post-operative treatment and follow-up outcomes were retrospectively analyzed. Results Meticulous anatomical microreplantation was successfully performed on all the 4 patients. Two of them received successfully bilateral penile dorsal arteries anastomosis, and the other two got only one dorsal artery anastomosis. All patients completed anastomosis of deep dorsal penile vein, and 3 of them had superficial dorsal vein anastomosis. Anastomosis of 4~6 dorsal nerves on both sides of the back of the penis were completed in all the patients. The operation time ranged from 6.5 to 7.5 h, with an average of 6.9 h. The warm ischemia period was 1~4 h, averagely 1.9 h. During the follow-up, 3 cases obtained successful penis replantation, although 2 of them had partial necrosis of foreskin, which healed naturally after 2~3 months. These 3 patients had normal urinations after operation, and had an erectile hardness score of 3~4 in 3~6 months after operation, with satisfactory self-reported recoveries. Conclusion For the patients with short warm ischemia period after complete penile amputation, microreplantation should be carried out as soon as possible in order to obtain satisfactory appearance and functional recovery of the penis.

Purpose: Ischemic time is a key factor in satisfactory functional results after forearm replantation. In this study, we provide a detailed description of our surgical technique, the temporary screw plate fixation technique, which aims to reduce ischemic time. Methods: From June 2007 to June 2017, we performed a retrospective study of 20 patients who underwent forearm replantation. Eighteen cases involved male patients, and their mean age was 46 years. The mechanism of injury was roller injuries in 5 cases, power saw injuries in 3 cases, traffic accident in 7 cases, rope injuries in 2 cases, machinery injuries in 2 cases, and crushing injuries by rebar beam in 1 case. Results: A total of 20 replantation patients survived. According to injury level, there were 3 cases of the proximal type, 11 cases of the middle type, and 6 cases of the distal type. The average time to revascularization was 331 min. The total operation time was, on average, 5.73 h. In the rest of the 18 cases, the temporary screw plate fixation technique was performed, and the average time required for bone shortening and plate fixation was 38.3 min. Conclusions: To reduce ischemic time, we need a plan that progressively reduces time at each stage. Among our tips, temporary screw plate fixation can reduce the initial bone surgical operation to < 40 min, does not have many complications, and can be used as definitive surgery. This method for bone fixation should be considered as a strategy to actively reduce operation time during forearm replantation. Level of evidence: Retrospective study, Level III. [ABSTRACT FROM AUTHOR]

Purpose: Bacterial infection is a critical complication influencing the survival of a replanted digit. This study aimed to identify risk factors for bacterial infection following zone 1 replantation. Methods: A retrospective chart review was conducted on patients who underwent zone 1 replantation from January 2016 to November 2022. The factors included in the comparative analysis were patient demographics (age, sex), past medical history (hypertension, diabetes mellitus), smoking, types of injury, degree of contamination, source of trauma, fractures, number of vascular anastomoses, use of salvage therapies, and the use of vein grafts. A bacterial infection was diagnosed based on observation of visible inflammatory signs with the results of culture studies. Results: In total, 313 patients were selected. Thirty-eight cases of bacterial infection were identified, which accounted for 12.1% of total patients. Methicillin-resistant Staphylococcus epidermidis (MRSE) was the most prevalent bacterium (63.2%, 24 of 38 cases). The patient and injury-related factors showed no significant differences, but the number of vein anastomoses and use of salvage therapy were significantly correlated with the occurrence of bacterial infection. Conclusion: Performing fewer vein anastomoses appears to increase the likelihood of a salvage procedure, and subsequently increases the risk of bacterial infection by an increased need for direct wound manipulation after zone 1 replantation. Infections caused by MRSE were more commonly identified than those by Aeromonas hydrophilia, which is a commonly known pathogen in medicinal leeches. [ABSTRACT FROM AUTHOR]

The replantation of multiple amputated digits is a technically challenging procedure for reconstructive surgeons that requires more time than the replantation of a single digit. We evaluated the effect of multiple-digit replantation on the success of digital replantation. Patients who experienced digital amputation and underwent digital replantation from January 2018 to December 2021 were studied retrospectively. Patients who experienced successful and failed replantation were compared, as were digits that survived or became necrotic after replantation. A multivariate logistic regression (MLR) analysis was performed to evaluate the independent factors of replanted digit survival. There were 378 patients with 497 amputated digits who underwent digital replantation. Of all 378 patients, 298 underwent single-digit replantation, and the other 80 patients underwent multiple-digit replantation. A total of 83.3% of the replanted digits survived (414 of 497). Compared with patients with surviving replanted digits, significantly more patients with necrotic replanted digits underwent multiple-digit replantation (37.7% vs. 17.5%, p < 0.001). On the other hand, a digit that developed necrosis after replantation was more likely to have been involved in the replantation of three or more digits (16% vs. 29%, p = 0.005). The subsequent MLR analysis revealed that the likelihood of necrosis was 2.355 (p = 0.003) times higher in the replantation of three or more digits than in the replantation of one or two digits. Patients who underwent multiple-digit replantation exhibited a higher incidence of necrosis in the replanted digits. In cases involving patients with multiple-digit amputation, it is crucial to prioritize and perform selective replantation based on the amputated digits. [ABSTRACT FROM AUTHOR]

Amputation of the testis is very rare in clinical situations; therefore, most surgeons have no experience with an amputated testis. In this case, a 31-year-old male with schizophrenia amputated both testes due to self-mutilation. We performed replantation surgery via microscopy. On postoperative day 1, he removed his right testis by using his hand, even though his hands were restrained. The second attack disrupted the viability of the right testis. However, after proper management, we checked the normal sex hormone level by preserving the replanted left testis. We evaluated the viability of the replanted testis by performing five examinations, namely, intraoperative indocyanine green injection, testicular scan with technetium pertechnetate, contrast-enhanced computerized tomography, Doppler ultrasonography, and serum testosterone level. In this report, we aimed to describe our rare experience about management with replantation of the amputated testes and evaluation of their viability. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]