The authors describe 3 cases with successful fingertip replantations using supermicrosurgical arteriole (terminal branch of digital artery) anastomoses, arteriole graft obtained from the same fingertip defect, reverse arteriole flow to subdermal venule, and delayed venular drainage for venous congestion. Among these 16 consecutive distal phalangeal replantations, 7 fingers showed postoperative venous congestion (43.8% of the total fingers) and 5 were reoperated on with delayed venous drainage under digital block. All the reoperated fingers were successfully drained by additional single or double venous drainage with a vein graft (100% success rate). As a result, 13 fingers survived (81.3% success rate).
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Article Synopsis
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- The article reviews various factors influencing the success of digital replantation, including survival rates, techniques to enhance outcomes, and unresolved questions like optimal number of vein anastomoses.
- As microsurgical advancements continue, the understanding of digital replantation's indications and contraindications evolves, emphasizing the need for ongoing research into anesthesia and postoperative care.
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