Management of vascular defects in digital replantation

Abstract

207 cases of digital amputation (261 digits) with vascular defects were replantated during the past two decades. The vascular defect was managed with various methods. 240 digits (92%) survived with good post-operative circulation and recovery of function. The methods of management of arterial defects were as follows: 1) Digital artery transfer from adjacent digits in 25 thumbs and three index fingers. All had survived. 2) Arterial transplantation: in 12 digits, arteries from the contralateral side or from the digits that were unsuitable for replantation were grafted to fill the arterial defects. All of these fingers survived. 3) Vein graft: superficial veins were taken to reconstruct the defects of the digital arteries in 59 digits, with 55 digits surviving and four failing. 4) Ulnar digital arterial flap of the ring finger. This technique was used in four digits with composite artery and soft tissue loss. All the cases survived. 5) Implantation of the arteries into the distal amputation parts. This was done in two digits with no arteries for anastomosis in the distal parts. The management of venous defects was as follows: 1) Transfer of veins from the adjacent digits. Five digits treated with this technique survived well. 2) Vein graft. Six digits survived but one failed. 3) A venous flap was done in six digits and all the digits survived after this procedure. 4) Arterio-venous anastomosis: this was used in 20 digits without suitable veins for anastomosis in replantation of the digit distal to the DIP joint level. 5) Replantation without venous return: a fish-mouth incision and heparin irrigation was used for venous drainage in 19 digits, with survival of 14. 6) The palmar venous system was anastomosed in 84 digits without dorsal veins for suture. 77 digits survived. 7) Venous fascial flap transfer: A composite venous fascial flap was harvested from the adjacent fingers. The flap was turned over on the side close to the injured finger to make an anastomosis of the veins with those in the distal amputated part. A skin graft was placed over the flap without a tie-over dressing. The pedicle was divided 3 weeks later. All the 16 digits with this technique survived well.