Distal and very distal digital replantations

Ninety-five patients with 98 complete or incomplete amputations of digits are reviewed. Three levels are considered according to the bony lesion, zone III being distal to the nail matrix. In this area, artery, nerve and vein repair need special techniques. The use of leeches in the absence of vein repair does not preclude an acceptable survival rate (68%), compared to the overall series (65.5%); however, smoking is detrimental (52%). Distal replantation is a fast and worthwhile procedure providing acceptable sensibility, no PIP limitation and good appearance at the price of a mean 74 days off work.