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The effect of dobutamine treatment on salvage of digital replantation and revascularization

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Abstract

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.

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Data availability

All data supporting the findings of this study are available within the paper.

References

  1. Janezic TF, Arnez ZM, Solinc M, Zaletel-Kragelj L. One hundred sixty-seven thumb replantations and revascularisations: early microvascular results. Microsurgery. 1996;17(5):259–63. https://doi.org/10.1002/(SICI)1098-2752(1996)17:5%3c259::AID-MICR4%3e3.0.CO;2-E.

    Article  CAS  PubMed  Google Scholar 

  2. Ma Z, Guo F, Qi J, Xiang W, Zhang J. Effects of non-surgical factors on digital replantation survival rate: a meta-analysis. J Hand Surg Eur. 2016;41(2):157–63. https://doi.org/10.1177/1753193415594572.

    Article  CAS  Google Scholar 

  3. Ural A, Bilgen F, Ceviz MD, Yanbas MR, Bekerecioglu M. Digital artery perforator flap use in reconstruction of fingertip defects. Selcuk Med J. 2020;36(4):343–51.

    Google Scholar 

  4. Walaszek I, Zyluk A. Long term follow-up after finger replantation. J Hand Surg Eur. 2008;33(1):59–64. https://doi.org/10.1177/1753193407088499.

    Article  CAS  Google Scholar 

  5. Hatchell AC, Sandre AR, McRae M, Farrokhyar F, Avram R. The success of salvage procedures for failing digital replants: a retrospective cohort study. Microsurgery. 2019;39(3):200–6. https://doi.org/10.1002/micr.30379.

    Article  PubMed  Google Scholar 

  6. Wang H. Secondary surgery after digit replantation: its incidence and sequence. Microsurgery. 2002;22(2):57–61. https://doi.org/10.1002/micr.21725.

    Article  PubMed  Google Scholar 

  7. Nishijima A, Yamamoto N, Yanagibayashi S, et al. The effect of smoking on necrosis rate in digital replantation and revascularization with prostaglandin E1 therapy: a retrospective study. Plast Reconstr Surg. 2016;138(4):848–53. https://doi.org/10.1097/PRS.0000000000002600.

    Article  CAS  PubMed  Google Scholar 

  8. Zhu H, Zhu X, Zheng X. Antithrombotic therapies in digit replantation with papaverine administration: a prospective observational study. Plast Reconstr Surg. 2017;140(4):743–6. https://doi.org/10.1097/PRS.0000000000003665.

    Article  CAS  PubMed  Google Scholar 

  9. Schumann J, Henrich EC, Strobl H, et al. Inotropic agents and vasodilator strategies for the treatment of cardiogenic shock or low cardiac output syndrome. Cochrane Database Syst Rev. 2018;1(1):009669. https://doi.org/10.1002/14651858.CD009669.pub3.

    Article  Google Scholar 

  10. Ruffolo RR Jr. The pharmacology of dobutamine. Am J Med Sci. 1987;294(4):244–8.

    Article  PubMed  Google Scholar 

  11. Rowlands TE, Gough MJ, Homer-Vanniasinkam S. Do prostaglandins have a salutary role in skeletal muscle ischaemia-reperfusion injury? Eur J Vasc Endovasc Surg. 1999;18(5):439–44. https://doi.org/10.1053/ejvs.1999.0929.

    Article  CAS  PubMed  Google Scholar 

  12. Scholz A, Pugh S, Fardy M, Shafik M, Hall JE. The effect of dobutamine on blood flow of free tissue transfer flaps during head and neck reconstructive surgery*. Anaesthesia. 2009;64(10):1089–93. https://doi.org/10.1111/j.1365-2044.2009.06055.x.

    Article  CAS  PubMed  Google Scholar 

  13. Morrison WA, McCombe D. Digital replantation. Hand Clin. 2007;23(1):1–12. https://doi.org/10.1016/j.hcl.2006.12.001.

    Article  PubMed  Google Scholar 

  14. Chaivanichsiri P, Rattanasrithong P. Type of injury and number of anastomosed vessels: impact on digital replantation. Microsurgery. 2006;26(3):151–4. https://doi.org/10.1002/micr.20181.

    Article  PubMed  Google Scholar 

  15. Daoutis N, Efstathopoulos D, Gerostathopoulos N, et al. Replantation of the thumb: survival rate and functional recovery in correlation with type of injury. Microsurgery. 1993;14(7):454–6. https://doi.org/10.1002/micr.1920140707.

    Article  CAS  PubMed  Google Scholar 

  16. Ozaksar K, Toros T, Sügün TS, Kayalar M, Kaplan I, Ada S. Finger replantations after ring avulsion amputations. J Hand Surg Eur. 2012;37(4):329–35. https://doi.org/10.1177/1753193411423877.

    Article  CAS  Google Scholar 

  17. Sears ED, Chung KC. Replantation of finger avulsion injuries: a systematic review of survival and functional outcomes. J Hand Surg Am. 2011;36(4):686–94. https://doi.org/10.1016/j.jhsa.2010.12.023.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Waikakul S, Sakkarnkosol S, Vanadurongwan V, Un-nanuntana A. Results of 1018 digital replantations in 552 patients. Injury. 2000;31(1):33–40. https://doi.org/10.1016/s0020-1383(99)00196-5.

    Article  CAS  PubMed  Google Scholar 

  19. Çinal H, Barın EZ, Kara M, et al. 277 Hand finger replantation: demographic characteristics and outcomes. Selcuk Med J. 2020;36(2):79–86 ([in Turkish]).

    Google Scholar 

  20. Sammer DM. Management of complications with flap procedures and replantation. Hand Clin. 2015;31(2):339–44. https://doi.org/10.1016/j.hcl.2015.01.008.

    Article  PubMed  Google Scholar 

  21. Smoot EC 3rd, Debs N, Banducci D, Poole M, Roth A. Leech therapy and bleeding wound techniques to relieve venous congestion. J Reconstr Microsurg. 1990;6(3):245–50. https://doi.org/10.1055/s-2007-1006825.

    Article  PubMed  Google Scholar 

  22. Nikolis A, Tahiri Y, St-Supery V, et al. Intravenous heparin use in digital replantation and revascularization: The Quebec Provincial Replantation program experience. Microsurgery. 2011;31(6):421–7. https://doi.org/10.1002/micr.20900.

    Article  PubMed  Google Scholar 

  23. Scott FA, Howar JW, Boswick JA Jr. Recovery of function following replantation and revascularization of amputated hand parts. J Trauma. 1981;21(3):204–14. https://doi.org/10.1097/00005373-198103000-00003.

    Article  CAS  PubMed  Google Scholar 

  24. Weiland AJ, Villarreal-Rios A, Kleinert HE, Kutz J, Atasoy E, Lister G. Replantation of digits and hands: analysis of surgical techniques and functional results in 71 patients with 86 replantations. J Hand Surg Am. 1977;2(1):1–12. https://doi.org/10.1016/s0363-5023(77)80002-6.

    Article  CAS  PubMed  Google Scholar 

  25. Breahna A, Siddiqui A, Fitzgerald O’Connor E, Iwuagwu FC. Replantation of digits: a review of predictive factors for survival. J Hand Surg Eur. 2016;41(7):753–7. https://doi.org/10.1177/1753193415624663.

    Article  CAS  Google Scholar 

  26. Oufquir A, Bakhach J, Panconi B, Guimberteau JC, Baudet J. Sauvetage des revascularisations digitales par administration intra-artérielle de fibrinolytiques [Salvage of digits replantations by direct arterial antithrombotic infusion]. Ann Chir Plast Esthet. 2006;51(6):471–81. https://doi.org/10.1016/j.anplas.2005.12.017.

    Article  CAS  PubMed  Google Scholar 

  27. Retrouvey H, Makerewich JR, Solaja O, Giuliano AM, Niazi AU, Baltzer HL. Effect of vasopressor use on digit survival after replantation and revascularization-a large retrospective cohort study. Microsurgery. 2020;40(1):5–11. https://doi.org/10.1002/micr.30461.

    Article  PubMed  Google Scholar 

  28. Kulahci Y, Bozkurt M, Sen H, et al. Microsurgery and anesthesia. Turk J Plast Surg. 2009;17(2):97–104.

    Google Scholar 

  29. Bozkurt M, Kulahci Y, Zor F, et al. Comparison of the effects of inhalation, epidural, spinal, and combined anesthesia techniques on rat cremaster muscle flap microcirculation. Microsurgery. 2010;30(1):55–60. https://doi.org/10.1002/micr.20719.

    Article  PubMed  Google Scholar 

  30. Paula-Ribeiro M, Garcia MM, Martinez DG, Lima JR, Laterza MC. Increased peripheral vascular resistance in male patients with traumatic lower limb amputation: one piece of the cardiovascular risk puzzle. Blood Press Monit. 2015;20(6):341–5. https://doi.org/10.1097/MBP.0000000000000148.

    Article  PubMed  Google Scholar 

  31. Pollard S, Edwin SB, Alaniz C. Vasopressor and Inotropic management of patients with septic shock. P T. 2015;40(7):438–50.

    PubMed  PubMed Central  Google Scholar 

  32. McNally EM. Can we do better than dobutamine? Circ Res. 2013;113(4):355–7. https://doi.org/10.1161/CIRCRESAHA.113.302000.

    Article  CAS  PubMed  Google Scholar 

  33. Kim SH, Moon YJ, Kim JW, Hong JY, Kim WJ, Hwang JH. Effective dose of dobutamine in augmenting free flap blood flow during reconstructive surgery of the lower extremity. Medicine (Baltimore). 2019;98(18):e15358. https://doi.org/10.1097/MD.0000000000015358.

    Article  CAS  PubMed  Google Scholar 

  34. Suominen S, Svartling N, Silvasti M, Niemi T, Kuokkanen H, Asko-Seljavaara S. The effect of intravenous dopamine and dobutamine on blood circulation during a microvascular TRAM flap operation. Ann Plast Surg. 2004;53(5):425–31. https://doi.org/10.1097/01.sap.0000137133.08105.73.

    Article  PubMed  Google Scholar 

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Funding

The authors received no financial support for the research, authorship, and/or publication of this article. None of the authors has a financial interest in any of the products, devices, or drugs mentioned in this manuscript.

Author information

Authors and Affiliations

  1. Department of Plastic, Reconstructive and Aesthetic Surgery, Meram Faculty of Medicine, Necmettin Erbakan University, Konya, Turkey

    Bilsev Ince & Mehmet Dadaci

  2. Department of Plastic, Reconstructive and Aesthetic Surgery, Basaksehir Cam and Sakura State Hospital, Istanbul, Turkey

    Orkun Uyanik

  3. Department of Plastic, Reconstructive and Aesthetic Surgery, Faculty of Medicine, Istinye University, Istanbul, Turkey

    Majid Ismayilzade

  4. Istanbul, Turkey

    Mehmet Emin Cem Yildirim

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  1. Bilsev Ince
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Contributions

BI: Conceptualization, project administration. OU: Data curation, writing—review and editing. MI: Investigation, writing—original draft. MECY: Resources. MD: Data curation, Formal analysis.

Corresponding author

Correspondence to Majid Ismayilzade.

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Conflict of interest

The research was not sponsored by an outside organization. We (all of the authors) have agreed to allow full access to the primary data and to allow the journal to review the data if requested.

Ethical approval

This study conformed to the Helsinki Declaration. Ethics committee approval was obtained. We (all of the authors) confirm that we have read the Journal’s position on issues involved in ethical publication and affirm that this report is consistent with those guidelines.

Informed consent

Written and verbal informed consents were obtained from the patients included in the study.

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Ince, B., Uyanik, O., Ismayilzade, M. et al. The effect of dobutamine treatment on salvage of digital replantation and revascularization. Eur J Trauma Emerg Surg 49, 2113–2120 (2023). https://doi.org/10.1007/s00068-023-02312-x

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  • DOI: https://doi.org/10.1007/s00068-023-02312-x

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