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Fingertip Replantation Without Venous Anastomosis.
MedLine Citation:
PMID:  22395045     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
BACKGROUND: Replantation of amputated fingertips is a technical challenge, as many salvage procedures fail because no suitable vein in the fingertip is available for anastomosis. In this study, we examined our experience in fingertip replantation in cases without venous anastomosis with our established fingertip replantation treatment protocol. METHODS: Between August 2002 and August 2010, a retrospective study examined all patients who had undergone fingertip replantation at Chang-Gung Memorial Hospital. All the patients (n = 24) suffered from complete digital amputations at or distal to the interphalangeal joint of the thumb, or distal to distal interphalangeal joint of the fingers. A total of 30 fingertips that were salvaged by microsurgical anastomosis of the digital arteries but not of digital veins were included in this study. On satisfactory arterial anastomosis, a 2-mm incision was made over the fingertip with a number 11 Scalpel blade, and 0.1 to 0.2 mL heparin (5000 IU/mL) was injected subcutaneously around the incision immediately and once per day thereafter to ensure continuous blood drainage from the replanted fingertip. None of the replanted nail plate was removed, and no medical leeches were used. The perfusion of the replanted digits and patient's hemoglobin level were closely monitored. The wound bleeding was maintained until physiologic venous outflow was restored. RESULTS: Of 30 fingertips, 27 (90%) replanted fingertips survived. The average length needed for maintaining external bleeding by chemical leech was 6.8 days (range, 5-10 days). Twelve patients (including a 2-year-old child) received blood transfusions. The average amount of blood transfusion in the 23 adults was 4.0 units (range, 0-16 units) for each patient or 3.29 units (range, 0-14 units) for each digit. A 2-year-old child received 100 mL blood transfusion or 50 mL for each digit. CONCLUSIONS: This study shown that a protocol that promotes controlled bleeding from the fingertip is essential to achieve consistent high success rate in fingertip replantation. The protocol is safe and reliable, as it avoids the use of medical leeches and the removal of nail plate from the replanted finger. However, full informed patient consent must include the potential need for transfusion and extended hospital stay.
Authors:
Yi-Chieh Chen; Fuan Chiang Chan; Chung-Chen Hsu; Yu-Te Lin; Chien-Tzung Chen; Chih-Hung Lin
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2012-3-6
Journal Detail:
Title:  Annals of plastic surgery     Volume:  -     ISSN:  1536-3708     ISO Abbreviation:  -     Publication Date:  2012 Mar 
Date Detail:
Created Date:  2012-3-7     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  7805336     Medline TA:  Ann Plast Surg     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Affiliation:
From the Department of Plastic & Reconstructive Surgery, Chang Gung Memorial Hospital and Chang Gung University, Linkou, Taiwan.
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