Digital replantations distal to the distal interphalangeal joint

Microvascular replantations of digits distal to the distal interphalangeal (DIP) joint were reviewed in 33 digits of 29 patients. Twenty-five digits were completely amputated and eight were incompletely amputated. Ten of 33 replants failed and 23 digits survived. Even without venous reconstruction, good results were obtained in Zone I. Of eight completely amputated digits in Zone 1 in which venous reconstruction was not performed, seven digits survived. Of four completely amputated digits in Zone 2 without venous reconstruction, all became necrotic. In digits followed for six months or more after surgery, 11 of 13 replantations showed good functional recovery. Two digits that developed paresthesia after replantation were functionally useless. Seven digits without bilateral digital nerve reconstruction were reviewed six months or more after surgery. Sensory recovery was good in the digital phalanx; the factor impeding functional recovery was the development of paresthesia. Replanted digits distal to the DIP joint are thus satisfactory in both function and cosmesis, even if digital nerves have not been reconstructed. The replantation of such digits should be considered.