Document Detail

Fingertip replantation without venous anastomosis.
MedLine Citation:
PMID:  22395045     Owner:  NLM     Status:  MEDLINE    
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 showed that a protocol that promotes controlled bleeding from the fingertip is essential to achieve consistent high success rates 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.
Yi-Chieh Chen; Fuan Chiang Chan; Chung-Chen Hsu; Yu-Te Lin; Chien-Tzung Chen; Chih-Hung Lin
Related Documents :
20528215 - Does the duration of gonadotropin stımulation affect embryo quality on post-retrieval ...
3931915 - Effect of cyclic estradiol valerate/levonorgestrel on periclimacteric syndrome and endo...
19438165 - In-office endometrial ablation and clinical correlation of reduced menstrual blood loss...
16437515 - Uterine artery embolization for symptomatic uterine fibroids.
9726615 - Ventricular remodelling and revascularization in severe left ventricular dysfunction.
10656365 - Submandibular salivary gland transfer prevents radiation-induced xerostomia.
Publication Detail:
Type:  Case Reports; Journal Article    
Journal Detail:
Title:  Annals of plastic surgery     Volume:  70     ISSN:  1536-3708     ISO Abbreviation:  Ann Plast Surg     Publication Date:  2013 Mar 
Date Detail:
Created Date:  2013-02-15     Completed Date:  2013-06-11     Revised Date:  2014-10-28    
Medline Journal Info:
Nlm Unique ID:  7805336     Medline TA:  Ann Plast Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  284-8     Citation Subset:  IM    
Export Citation:
APA/MLA Format     Download EndNote     Download BibTex
MeSH Terms
Amputation, Traumatic / surgery*
Anastomosis, Surgical
Blood Transfusion
Child, Preschool
Finger Injuries / surgery*
Finger Phalanges / blood supply*,  surgery
Limb Salvage / methods,  standards
Microsurgery / methods,  standards
Middle Aged
Replantation / methods,  standards*
Retrospective Studies
Young Adult
Comment In:
Ann Plast Surg. 2014 Oct;73(4):473   [PMID:  23903087 ]
Ann Plast Surg. 2014 Oct;73(4):473-4   [PMID:  24135641 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

Previous Document:  Intraoperative prediction of postoperative flap outcome using the near-infrared fluorophore methylen...
Next Document:  Closure of the Radial Forearm Donor Site Using a Local Hatchet Flap: Analysis of 45 Consecutive Case...