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Standardized protocol for artery-only fingertip replantation
Rudolf F Buntic1, Darrell Brooks
1Buncke Clinic, Department of Plastic Surgery, California Pacific Medical Center, San Francisco, CA 94114, USA.
The Journal of Hand Surgery
|September 3, 2010
Summary
Artery-only fingertip replantation is reliable with a protocol promoting controlled bleeding and anticoagulation. This method ensures replant survival, though it may require transfusions and extended hospital stays.
Area of Science:
- Microsurgery
- Vascular Surgery
- Reconstructive Surgery
Background:
- Artery-only fingertip replantation requires maintaining low-resistance flow until natural venous outflow is established.
- Traditional methods involve injuring the replant to promote bleeding, often leading to prolonged hospitalization.
Purpose of the Study:
- To analyze the outcomes of artery-only fingertip replantation using a standardized postoperative protocol.
- To evaluate a protocol involving dextran-40, heparin, and leech therapy for maintaining replant viability.
Main Methods:
- 19 artery-only fingertip replants were performed on 17 patients between 2001 and 2008.
- A protocol included nail plate removal, intravenous dextran-40, heparin, aspirin, medicinal leeches, and mechanical heparin scrubbing.
- Anticoagulation was titrated to control bleeding until neovascularization restored venous outflow, monitored by fluorescent dye studies.
Main Results:
- All 19 fingertip replants survived.
- The average hospital stay was 9 days (range, 7-17 days).
- Eleven patients received an average of 1.8 units of blood transfusion (range, 0-9 units).
Conclusions:
- The described protocol for promoting temporary, controlled fingertip bleeding is safe and reliable for artery-only replants.
- This approach protects replants distal to the distal interphalangeal joint until venous outflow is restored.
- Patients should be counseled on potential transfusions and extended hospital stays when considering this replantation technique.
