gms | German Medical Science

14th Triennial Congress of the International Federation of Societies for Surgery of the Hand (IFSSH), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT)

17.06. - 21.06.2019, Berlin

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Artery-only fingertip replantation distal to lunula: A retrospective analysis of clinical results

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  • presenting/speaker Yasunori Kaneshiro - Hand and Microsurgery Center, Seikeikai Hospital, Sakai, Japan
  • Koichi Yano - Hand and Microsurgery Center, Seikeikai Hospital, Sakai, Japan
  • Sengho Hyun - Hand and Microsurgery Center, Seikeikai Hospital, Sakai, Japan
  • Hideki Sakanaka - Hand and Microsurgery Center, Seikeikai Hospital, Sakai, Japan

International Federation of Societies for Surgery of the Hand. International Federation of Societies for Hand Therapy. 14th Triennial Congress of the International Federation of Societies for Surgery of the Hand (IFSSH), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT). Berlin, 17.-21.06.2019. Düsseldorf: German Medical Science GMS Publishing House; 2020. DocIFSSH19-371

doi: 10.3205/19ifssh0231, urn:nbn:de:0183-19ifssh02318

Published: February 6, 2020

© 2020 Kaneshiro et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.

Outline

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Objectives/Interrogation: Both arterial and venous repair are crucial for optimal results in digital replantation. However, anastomosis of veins becomes challenging in very distal fingertip amputation because of small vessel diameter or unavailability by damage. The purpose of this study is to investigate the clinical results of artery-only replantation without vein repair for very distal fingertip amputation.

Methods: We performed a retrospective review of 47 digits of 39 patients who had undergone fingertip replantation between 2015 and 2017. All patients in this study had complete fingertip amputation distal to the lunula. By Ishilawa's classification, 12 digits in subzone I, and 35 digits in subzone II. Only one central artery repair distal to arch was performed. All patients received the postoperative protocol including external bleeding with or without the use of medical leech, and anticoagulation therapy for a week until physiological outflow was restored. Clinical outcomes including range of motion, grip strength, and sensory recovery assessed by modified Highet scale at the final follow-up for the patients with the minimum follow-up period of 6 months were reviewed and analyzed.

Results and Conclusions: The mechanism of injury was crush in 16, clean in 10, blunt in 10, and avulsion in 11 patients. The mean ischemia time was 6.0 hours. Complete survival was observed in 30 out of the 47 fingertip replantation (64%). There was statistically significant difference between amputation level and survival rate (91% for subzone I, 54% for subzone II, respectively, p=0.02). There was statistically significant difference between mechanism of injury and survival rate (85% for clean/blunt injury, 48% for crush/avulsion injury, respectively, p<0.01). At the final follow-up, the mean total active motion of surviving digits was 84% of normal side. The mean grip strength was 80% of normal side. Sensory recovery was classified as S1, S2, S3 and S4 for 5, 22, 5 and 0 digits, respectively.

This study suggested that artery-only fingertip for fingertip replantation distal to lunula including many crush/avulsion injuries achieved satisfactory survival rate and good clinical outcomes. Both amputation level of subzone II and crush/avulsion injury were associated with lower survival rate.