Distal Digit Replantation: Challenges and Strategies to Improve Outcomes

Digit replantation has undergone significant advancements since the 1960s. Despite progress, distal digit replantation remains one of the most challenging microsurgical procedures due to technical and clinical complexities. This review examines current challenges, strategic solutions in distal digit replantation, grounded in clinical experience and literature review. Key obstacles include managing minute vessel structures, venous congestion, and the critical condition of no available vessels for revascularization. Advances in surgical techniques, including preosteosynthesis vein grafting, intravascular stent, solitary central pulp artery bifurcation division, subdermal pocketing method, and postoperative management, have enhanced outcomes.