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Recent Topics on Fingertip Replantations Under Digital Block
Isao Koshima1, Shuhei Yoshida1, Hirofumi Imai1
1International Center for Lymphedema, Hiroshima University Hospital, 1-2-3, Kasumi, Minami-ku, Hiroshima City 734-8551, Japan.
Hand Clinics
|April 1, 2019
Summary
Successful fingertip replantations were achieved using supermicrosurgery and delayed venous drainage techniques. This approach improved survival rates for distal phalangeal replantations, addressing venous congestion effectively.
Area of Science:
- Reconstructive Microsurgery
- Vascular Surgery
- Trauma Surgery
Background:
- Fingertip replantation is challenging due to the small caliber of vessels.
- Venous congestion is a common complication, leading to replantation failure.
- Supermicrosurgical techniques offer potential for improved outcomes in distal replantations.
Purpose of the Study:
- To describe a supermicrosurgical technique for successful fingertip replantation.
- To evaluate the efficacy of delayed venous drainage for managing postoperative venous congestion.
- To report the outcomes of distal phalangeal replantations using these methods.
Main Methods:
- Supermicrosurgical arteriole anastomoses using terminal digital artery branches.
- Arteriole grafting from the fingertip defect and reverse arteriole flow to subdermal venules.
- Delayed venular drainage under digital block for managing venous congestion, including vein grafting.
Main Results:
- Successful replantation in 13 out of 16 cases (81.3% survival rate).
- Postoperative venous congestion occurred in 7 fingers (43.8%).
- Reoperation with delayed venous drainage (with vein grafts) achieved a 100% success rate in resolving congestion.
Conclusions:
- Supermicrosurgical techniques, including arteriole anastomoses and grafts, are effective for fingertip replantation.
- Delayed venous drainage is a successful strategy for managing postoperative venous congestion.
- This combined approach significantly improves the success rate of distal phalangeal replantations.
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