Survival Rate of Revascularization and Replantation of Digits with Vein Graft Versus Direct Arterial Anastomosis

Abstract

There is no financial information to disclose. The use of vein graft in revascularization and replantation of dysvascular digit yields survival rates similar to direct arterial anastomosis. A retrospective review of all patients > 18 years old at a public urban teaching hospital from 2007 to 2017 that required revascularization and/or replantation of one or more digits due to traumatic full or partial amputation was performed. Demographic data, mechanism of injury, level of injury, and digits requiring revascularization and/or replantation were collected. In addition, length of vein graft used, donor site, and use of graft (for artery or vein) were collected. Digit survival was the primary outcome measure. 135 patients (129 male, 6 female) were identified with 186 affected digits, 127 of which required revascularization and 59 replantation. The data set included 39 thumb, 36 index, 54 middle, 38 ring, and 19 small digits. The average length of stay was 9.2 days. The average peri-operative transfusion requirement was 1.1 units (range 0-13). Vein graft for arterial anastomosis was utilized in 45.7% of all digits (53% of replanted and 40% of revascularized digits). The average vein graft length was 4.4 cm (range 0.15-12 cm). The overall digit survival rate was 80%. The 81% survival rate of digits requiring a vein graft was not different (P = 0.74) than the 79% survival rate of those that underwent direct arterial anastomosis. Similarly, the survival rate of revascularized digits was not different for digits treated with or without a vein graft (93% survival for both vein grafted digits and for those treated with direct arterial anastamosis, P = 0.86). Finally, digits replanted with a vein graft survived 53% of the time compared to the 52% survival rate of those replanted without the use of a vein graft, which was also not statistically different (P = 0.94). •Vein grafts were utilized for arterial repairs in nearly half of all dysvascular digits that underwent revascularization or replantation.•There was no statistical difference in the survival rate of dysvascular digits treated with a vein graft versus those that underwent direct arterial anastomosis.•The need for a vein graft for a large zone of injury should not be considered a relative contraindication to perform revascularization or replantation of dysvascular digits.•If the zone of injury is large, surgeons should have a low threshold to use vein grafts for the revascularization or replantation of digits.