Arch Hand Microsurg.  2023 Sep;28(3):158-165. 10.12790/ahm.23.0023.

Risk factors for bacterial infection following replantation of zone 1 amputation

• Lee DC
• Park CJ
• Kim JS
• Koh SH
• Roh SY
• Lee KJ

• KMID: 2545526
• DOI: http://doi.org/10.12790/ahm.23.0023

Abstract

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.

Keyword

Surgical amputation; Replantation; Bacterial infections; Trauma; Finger injuries

Figure

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  Fig. 1. (A) Group A, clean-cut injury. (B) Group B, partial crushing with petechiae on the skin. (C) Group C, severe crushing with a red line sign suggesting vessel damage.

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  Fig. 2. Classification of the degree of contamination. (A) Grade 1 with no visible contamination. (B) Grade 2 with visible contamination on less than 50% of the cut surface. (C) Grade 3 with visible contamination on more than 50% of the cut surface.

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  Fig. 3. Results of bacterial wound cultures. Pie chart indicating the wound cultures of zone 1 replantation. MRSA, methicillin-resistant Staphylococcus aureus; MRSE, methicillin-resistant Staphylococcus epidermidis.

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  Fig. 4. (A) Preoperative photograph. (B) Immediate postoperative photograph. (C) Observation of a bacterial infection on postoperative day 7. (D) Follow-up photograph on postoperative day 29.

Reference

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