Limiting Levels of Fingertip Replantation Without Venous Anastomosis

Tatsuya Hara; Shigeru Kurimoto; Toshikazu Kurahashi; Yutaro Kuwahara; Hiroki Takeshige; Shiro Urata

doi:10.1016/j.jhsa.2023.04.013

Limiting Levels of Fingertip Replantation Without Venous Anastomosis

J Hand Surg Am. 2023 May 29:S0363-5023(23)00191-0. doi: 10.1016/j.jhsa.2023.04.013. Online ahead of print.

Authors

Tatsuya Hara¹, Shigeru Kurimoto², Toshikazu Kurahashi³, Yutaro Kuwahara³, Hiroki Takeshige³, Shiro Urata³

Affiliations

¹ Department of Orthopedic Surgery, Anjo Kosei Hospital, Anjo, Japan. Electronic address: hara17jp@hotmail.com.
² Department of Hand Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan.
³ Department of Orthopedic Surgery, Anjo Kosei Hospital, Anjo, Japan.

PMID: 37256249
DOI: 10.1016/j.jhsa.2023.04.013

Abstract

Purpose: This study aimed to compare the success rates of fingertip replantation with and without venous anastomosis.

Methods: This retrospective study included 132 patients with 148 fingertip injuries who had undergone fingertip replantation (Ishikawa's classification I‒IV) between 2003 and 2020 at our hospital. Among them, 117 and 15 were men and women respectively, and their mean age was 43 years. There were 53, 44, and 51 fingertips with Ishikawa subzone II, III, and IV amputations respectively, and no cases were classified as Ishikawa subzone I. Venous anastomosis was performed on 64 fingertips (group A). This was not possible in the remaining 84 fingertips; thus, an external bleeding method was used (group B). Our external bleeding protocol consisted of 4-hourly skin pricks of the distal pulp with a 23-gauge needle for the first 5 days. The analyses included survival rates, hemoglobin levels (Hb), and blood transfusions administered.

Results: The overall survival rate was 90.5% (134 of 148). In group A, survival was achieved in 92.3%, 100%, and 94.3% of those with subzones II, III, and IV amputations, respectively. In group B, survival was achieved in 100%, 82.1%, and 62.5% of those with subzones II, III, and IV, respectively. Subzone IV in group B showed a significantly lower rate of replantation success. In groups A and B, the preoperative and 7-day postoperative Hb levels were 14.5 g/dL and 14.6 g/dL, and 11.3 g/dL, and 11.6 g/dL, respectively. In addition, blood transfusion was required for five patients (7.9%) in group A and six patients (7.9%) in group B. Thus, the Hb levels and blood transfusion administered were similar between the two groups.

Conclusions: Subzone IV is an important threshold for artery-only replantation. Furthermore, our external bleeding protocol is a safe and effective method.

Type of study/level of evidence: Therapeutic IV.

Keywords: Fingertip; replantation; venous anastomosis.