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Plast Reconstr Surg. 2018 Dec 26. doi: 10.1097/PRS.0000000000005343. [Epub ahead of print]

Survival after digit replantation and revascularization is not affected by the use of interpositional grafts during arterial repair.

Author information

1
Hansjörg Wyss Department of Plastic Surgery, NYU Langone Health, New York, New York.
2
Department of Orthopaedic Surgery, Hospital for Joint Diseases, NYU Langone Health, New York, New York.

Abstract

INTRODUCTION:

Interpositional grafts (IG) can be used to reconstruct the digital artery during revascularization and replantation when primary repair is not possible. The purpose of this study is to determine the effect of using interpositional graft on rates of digit survival.

METHODS:

A retrospective review of all patients from 2007 to 2016 that required revascularization and/or replantation of one or more digits was performed.

RESULTS:

127 patients were identified with 171 affected digits (118 digital revascularizations, 53 digital replantation). A graft was used to repair the digital artery in 50% (59 of 118) of revascularizations and in 49% (26 of 53) of replantations. There was no difference in digit survival with use of an IG for arterial repair vs. primary repair in revascularization (91.5% in both groups) or replantation (48.1% vs. 46.2%, p = 0.88). Regression analysis demonstrated no association between use of IG and digit survival. The source of IG did not have any effect on digit survival (p=0.97). IG was more likely to be used in crush (62.5%) and avulsion injuries (72.2%) compared to sharp laceration injuries (11.1 %) with RR = 5.6 (p=0.01) and RR = 6.5 (p=0.006) respectively.

CONCLUSION:

There was no difference in the survival rate of amputated digits that required IG for arterial repair. The need for an IG in a large zone of injury should not be considered a contraindication to performing revascularization or replantation. Furthermore, hand surgeons should have a low threshold for using IG especially in crush or avulsion injuries.

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