Results of Replantation of Amputated Fingertips in 450 Patients

ABSTRACT

Over a 15-year period (August, 1988 to May 2003), the authors have carried out 510 replantations of amputated fingertips distal to the nail base (zone I) in 450 patients, with a high overall survival rate (92 percent), using combinations of arterial and venous anastomoses without any alternative methods such as “pocketing.”

Replantations that anastomosed only one artery (25 digits) had a success rate of 68 percent, one artery and one vein (115 digits) had a success rate of 82 percent, one artery and two veins (240 digits) had a success rate of 95 percent and more than two artery and vein anastomoses (130 digits), had a success rate of 99 percent. The follow-up period ranged from 3 months to 14 years and 432 patients were followed-up more than 6 months. In these latter patients, the average two-point discrimination was 7 mm.

Fingertip - amputation - replantation

REFERENCES

• 1 Malt R A, McKhann C F. Replantation of severed arms.  JAMA. 1964;  189 716-722
• 2 Komatsu S, Tamai S. Successful replantation on a completely cut-off thumb.  Plast Reconstr Surg. 1968;  42 374
• 3 Kim K S, Eo S R, Kim D Y, Lee S Y, Cho B H. A new strategy of fingertip replantation: sequential use of microsurgical technique and pocketing of composite graft.  Plast Reconstr Surg. 2001;  107 73-79
• 4 Lee P K, Ahn S T, Lim P. Replantation of fingertip amputation by using the pocket principle in adults.  Plast Reconstr Surg. 1999;  103 1428-1435
• 5 Lin T S, Jeng S F, Chiang Y C. Fingertip replantation using the subdermal pocket procedure.  Plast Reconstr Surg. 2004;  113 247-253
• 6 Tsai T M, Mccabe S J, Maki Y. A technique for replantation of the finger tip.  Microsurgery. 1989;  10 1-4
• 7 Yamano Y. Replantation of fingertips.  J Hand Surg Br. 1993;  18 157-162
• 8 Kim W K, Lim J H, Han S K. Fingertip replantations: clinical evaluation of 135 digits.  Plast Reconstr Surg. 1996;  98 470-476
• 9 Hattori Y, Doi K, Ikeda K, Abe Y, Dhawan V. Significance of venous anastomosis in fingertip replantation.  Plast Reconstr Surg. 2003;  111 1151-1158
• 10 Goldner R D, Stevanovic M V, Nunley J A, Urbaniak J R. Digital replantation at the level of the distal interphalangeal joint and the distal phalanx.  J Hand Surg Am. 1989;  14 214-220
• 11 Tark K C, Kim Y W, Lee Y H, Lew J D. Replanation and revascularization of hands: Clinical analysis and functional results of 261 cases.  J Hand Surg Am. 1989;  14 17-27
• 12 Cheng G L, Pan D D, Qu Z Y et al.. Digital replantation: A ten-year retrospective study.  Chin Med J. 1991;  104 96-102
• 13 Strauch B, De Moura W D. Arterial system of the fingers.  J Hand Surg Am. 1990;  15 148-154
• 14 Smith D O, Oura C, Kimura C, Toshimori K. The distal venous anatomy of the finger.  J Hand Surg Am. 1991;  16 303-307
• 15 Moss S H, Schwartz K S, von Drasek-Ascher G, Ogden 2nd L L, Wheeler C S, Lister G D. Distal venous anatomy.  J Hand Surg Am. 1985;  10 473-482
• 16 Matsuda M, Chikamatsu E, Shimizu Y. Correlation between number of anastomosed vessels and survival rate in finger replantation.  J Reconstr Microsurg. 1993;  9 1-4
• 17 Lee B I, Chung H Y, Kim W K, Kim S W, Dhong E S. The effects of the number and ratio of repaired arteries and veins on the survival rate in digital replantation.  Ann Plast Surg. 2000;  44 288-294
• 18 Han S K, Chung H S, Kim W K. The timing of neovascularization in fingertip replantation by external bleeding.  Plast Reconstr Surg. 2002;  110 1042-1046