Survival rates and risk factors for failure using an interposition vein graft for fingertip amputations with segmental vessel defects

Abstract

This study aimed to compare survival rates and risk factors of replantation failures using an interposition vein graft in fingertip amputations with segmental vessel defects with those using simple end-to-end anastomosis in amputations. Between 2004 and 2015, 776 (647 males and 129 females) with single Zone I or II amputations of digits underwent replantation. Among these, simple end-to-end anastomosis was performed in 698 replantations, while interposition vein grafts were used for either arterial or venous repair or both in 78 amputated fingertips. The survival rate was compared between the groups. Logistic regression analysis was performed to identify risk factors predicting replantation failure in all study subjects. Among 776 replantations, 713 (91.9%) survived. At latest follow-up, of 698 cases in the simple anastomosis group, 650 (93.1%) survived; of 78 cases in the vein graft group, 63 (80.8%) survived (p > .001). Logistic regression analysis revealed that avulsion type (odds ratio [OR] 3.121; 95% confidence interval [CI], 1.211-8.064; p = .018) and zone II amputation (OR, 2.370; 95% CI, 1.382-4.065; p = .002) were significant risk factors for replantation failure. This study demonstrates that the survival rate (80.8%) of the vein graft in fingertip amputation with segmental vessel defects was shown to be a possible option to increase the survival rates in case with segmental vessel defects where simple anastomosis could not be performed. However, avulsion type and zone II amputation are important risk factors of replantation failures.