Delayed-onset functional ischemia 16 years after digital replantation: A Raynaud's-like vasospasm case report

Reports of long-term complications following finger replantation are scarce. Vascular crises occurring more than a decade after surgery are particularly rare. We present the case of a 27-year-old male who developed with acute cyanosis and reduced skin temperature of the left index finger, occurring 16 years after digital replantation. The patient had undergone replantation of the left index and middle fingers in childhood. He reported chronic smoking and frequent cold-water exposure prior to symptom onset. Imaging demonstrated narrowing of the proper palmar digital artery of the index finger, with diminished distal perfusion and no evidence of mechanical obstruction. Ambulatory blood pressure monitoring revealed uncontrolled hypertension (141/101 mmHg). Based on his risk factors and imaging findings, a diagnosis of vasospastic ischemia, consistent with a Raynaud's-like phenomenon likely triggered by tobacco use and cold exposure, was made. The patient responded well to infrared thermotherapy and vasoactive agents (nifedipine, bisoprolol, and beraprost sodium), with complete resolution of symptoms. This case highlights that replanted digits, due to incomplete reconstruction of the microvascular network, may remain vulnerable to vasospastic insults even many years later. It underscores the importance of lifelong risk mitigation, particularly the avoidance of reversible triggers such as smoking and cold exposure.