Differentiation and management of vascular crisis following replantation of the avulsed distal finger

Abstract

Objective To explore the differentiation and treatment of vascular crisis and necrosis after replantation of the distal fmger that was amputated at the distal interphalangeal joint with complex rotation avulsion injury.Methods Ten cases of 12 fingers and thumbs mutilated from distal to the nail base or from the distal interphalangeal joint were treated with replantation.Vascular crisis occurred 3 to 4 days post-replantation.Vein drainage was provided by nail removal or small lateral incision to allow bleeding from the nail bed or the incision.Dressing change and anticoagulants were applied.After 2 weeks observation the stitches were removed and the necrotic tissue peeled off to reveal a viable finger tip.Results All 12 replants survived.Postoperative followup period ranged from 6 to 36 months with an average of 26 months.All the patients were satisfied with the appearance and function of the replanted fingers.Static 2-point discrimination(S2PD)was 3.2 to 5.0 mm (mean,4.2 mm)at the finger pulp.Sensory recovery reached S3 to S3+.According to the criteria for function of reconstructed thumb and fingers issued by the Hand Surgery Society of the Chinese Medical Association the results were rated excellent in 8 fingers and good in 4 fingers,achieving 100％ satisfactory rate.Conclusion Pseudo-vascular crisis and necrosis after replantation of the distal interphalangeal joint amputated with complex rotation avulsion injury is common.Correct treatment can improve survival,achieve good functional and esthetical recovery and avoid unnecessary amputation. Key words: Replantation; Finger injuries; Therapy,combined modality