The Role of Continuous Irrigation in Replantation of Avulsed Thumbs

Wang Xingdong; Sun Zhenjie; Li Zhiwei

Abstract：Objective To investigate the role of limited closed continuous irrigation in reducing the occurrence of vascular crisis and preventing necrosis of replanted bodies during the treatment of avulsed thumb.Methods A retrospective study was conducted on 104 patients with rotational avulsed thumb admitted to the department of orthopaedics of Beijing No.6 Hospital from January 2023 to June 2024[89 males and 15 females,aged 25～69 years,mean age(51.5±9.2)years].The patients in the control group underwent radial digital proper arterial of the index finger or combined with principal artery of thumb transference.The patients in the experimental group were placed a flushing tube and received continuous warm irrigation besides the same surgery as the control group.The following outcomes were compared between the two groups:incidence of vascular crisis within the first postoperative week;serum procalcitonin(PCT),C-reactive protein(CRP)and erythrocyte sedimentation rate(ESR)on postoperative days 1,3 and 7;incidence of replant edema within three weeks;hand function scores and survival rate at six months.Results All 104 patients completed six-month follow-up.Within the first postoperative week,the incidence of vascular crisis on days 1,3 and 7 was 3.8％,1.9％and 0 in the experimental group,respectively,versus 11.5％,9.6％and 7.7％in the control group(P＜0.05).On postoperative days 1,3 and 7,PCT levels in the experimental group were(2.3±0.9)ng/mL,(1.0±0.5)ng/mL and(0.4±0.2)ng/mL,compared with(2.4±0.8)ng/mL,(1.7±0.7)ng/mL and(0.7±0.5)ng/mL in the control group;the difference on day 1 was not significant(P=0.177),whereas levels on days 3 and 7 were significantly lower in the experimental group(P＜0.05).On postoperative days 1,3 and 7,ESR and CRP in the experimental group were(46.8±8.1)mm/h,(21.6±4.3)mm/h,(13.5±2.8)mm/h and(38.5±15.9)mg/L,(2.2±2.3)mg/L,(2.0±3.1)mg/L,respectively,while those in the control group were(65.5±7.2)mm/h,(49.2±8.5)mm/h,(21.8±3.9)mm/h and(88.7±24.2)mg/L,(15.0±8.6)mg/L,(8.1±2.9)mg/L;all values were significantly lower in the experimental group(P＜0.05)and decreased more rapidly over time.In the first and second postoperative weeks,the incidence of edema in the replanted thumb was 9.6％and 19.2％in the experimental group versus 57.7％and 38.5％in the control group(P＜0.05);in the third week,edema rates were 9.6％and 23.1％.with no significant difference(P＞0.05).At six months postoperatively,the excellent-to-good rate of hand function was 100％in the experimental group and 86.5％in the control group.Conclusion Arterial transference combined with limited closed continuous irrigation effectively reduces the inflammatory response,lowers the incidence of vascular crisis and early edema,and improves the survival rate and functional outcomes of replanted thumbs following avulsed thumb replantation.