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Complicated Replanted Finger, 34 Years after Revascularization
Bert Vanmierlo1, Tim Vanmierlo2,3, Jean Goubau4,5
1Department of Orthopaedics and Traumatology, AZ Delta, Roeselare, Belgium.
Plastic and Reconstructive Surgery. Global Open
|December 10, 2020
Summary
This case report details a rare late failure of digital replantation 34 years post-surgery. Optimizing arterial anastomoses may improve long-term replantation success.
Area of Science:
- Microsurgery
- Vascular Surgery
- Reconstructive Surgery
Background:
- Late failure of digital replantation is uncommon, with limited literature on causative factors.
- Digital replantation involves unique challenges due to smaller surface areas for neovascularization compared to other free flaps.
Observation:
- An 87-year-old male presented with acute complications 34 years after digital replantation surgery.
- Diagnostic imaging revealed arterial anastomosis occlusion in the replanted digit.
- The patient had a history of prior replantation surgery on the index and middle fingers.
Findings:
- The patient's age and comorbidities precluded revascularization, with treatment focused on wound care and analgesia.
- Despite initial deterioration and ulceration, the wound eventually healed over 3 months.
- Factors like smaller contact surface area and circulatory diseases increase the risk of late replantation failure.
Implications:
- Performing dual volar digital arterial anastomoses, when feasible, could potentially decrease both early and late failure rates in digital replantation.
- Understanding risk factors is crucial for improving outcomes in digital replantation surgery.
