Outcomes of Artery-Only Digital Replantation

There is a growing consensus that replanted fingertips can survive with arterial anastomosis alone. This study aimed to evaluate outcomes among individuals undergoing artery-only replantation compared with those undergoing both arterial and venous replantation and to identify factors associated with outcomes.

This single-center, noninterventional, retrospective cohort study included 177 patients (207 digits) who underwent replantation of Tamai zones I, II, and III at our institution between January 2000 and December 2024. Age, sex, comorbidities, active smoking status, affected side and digit, amputation aspect, fracture type and mechanism, arterial diameter, arterial diameter difference, arterial diameter ratio, vein grafting, warm ischemic time, blood transfusion, and outcomes were investigated and compared between artery-only and nonartery-only replantation groups.

The arterial diameter was smaller in the artery-only replantation group, whereas nerve suturing was more frequent in the nonartery-only replantation group. Only two patients who underwent four-digit replantation required blood transfusion. There were no statistically significant differences in outcomes between the artery-only and nonartery-only replantation groups either in the overall cohort or within each zone.

Venous anastomosis should not be pursued excessively, particularly in fingertip replantation. Even for Tamai zone III, it is worthwhile to attempt replantation using artery-only techniques. Neither arterial diameter nor digital injury severity affected outcomes. There is no need for external bleeding at a level that necessitates blood transfusion in artery-only replantation.

Therapeutic III.