Fingertip replantation at or distal to the nail base: use of the technique of artery-only anastomosis

Ann Plast Surg. 2001 Jun;46(6):605-12. doi: 10.1097/00000637-200106000-00006.

Abstract

The authors describe the functional and aesthetic results of microsurgical replantation of 21 fingertip amputations at or distal to the nail base-namely, zone I amputations. There were 15 male and 6 female patients, with an average age of 26 years (age range, 1-41 years). Replantations were performed using the anastomosis of the artery-only technique, with neither vein nor nerve repair. Venous drainage was provided by an external bleeding method with a fish-mouth incision in "distal" zone I amputations for approximately 7 days, and by the use of leeches in more "proximal" zone I amputations for 10 to 12 days. Results indicated that the overall survival rate was 76%, with 16 of 21 digits surviving. Sensory evaluation at an average follow-up of 12 months (range, 6-18 months) revealed an average static two-point discrimination of 6.1 mm (range, 2.0-8.0 mm). Considering the unfavorable results and the donor site morbidity of various fingertip reconstructions, a microsurgical fingertip replantation should always be considered except in extremely distal, clean-cut, pediatric cases, in which case a composite graft is a possibility. The results of this series indicate that an amputated fingertip in zone I can be salvaged successfully by microvascular anastomosis of the artery only, with a nonmicrosurgical method of venous drainage. Furthermore, acceptable sensory recovery can be expected without any nerve coaptation.

Publication types

  • Case Reports

MeSH terms

  • Adolescent
  • Adult
  • Amputation, Traumatic / surgery*
  • Anastomosis, Surgical
  • Arteries / surgery
  • Child
  • Child, Preschool
  • Female
  • Finger Injuries / surgery*
  • Fingers / blood supply
  • Fingers / surgery*
  • Humans
  • Infant
  • Male
  • Replantation / methods*