gms | German Medical Science

Objectives/Interrogation: Currently there is little literature on the use of negative pressure wound therapy (NPWT) to overcome venous congestion in fingertip reimplantation. As in free flaps, venous congestion has demonstrated to be one of the main causes of partial or total lose. In the literature NPWT has demonstrated a high success rate in salvaging free flaps with venous congestion. NPWT is known to increase local blood flow, decrease edema, stimulate granulation tissue, and decrease the concentration of reactive oxygen species hens reducing the likelihood of soft tissue infection. Given the forth mentioned we used NPWT in fingertip reimplantations, which suffered venous congestion. With this we wished to demonstrate NPWT could be successful in overcoming venous congestion in fingertip reimplantation, salvaging the reimplanted segment.

Methods: A retrospective analysis was performed on two cases of fingertip reimplantation in which NPWT was used to overcome venous congestion and persistent edema. Patients where followed for at least a year ensuring adequate functionality given by protective sensibility of the fingertip, movement that allowed day to day activities and return to normal life.

Results and Conclusions: Two patients with fingertip amputation where included, a male with a left thumb injury (Allen IV) and a female with a right index injury (Allen IV). In both cases venous congestion presented after reimplantation was carried out on an average of 2 days. Continuous NPWT was then applied improving the venous drainage and resolving tissue edema and venous insufficiency, which enabled total fingertip salvage. Both patients recovered protective sensibility, returned to their normal life activities and have a functional finger.

NPWT is a useful instrument in managing and improving venous congestion in fingertip reimplantation. Even though further and larger studies are necessary on the use of NPWT and its role in venous congestion in fingertip reimplantation it is a solution that has demonstrated high efficacy to salvage a fingertip that present venous congestion. It is a nonsurgical alternative that has demonstrated high success rate with minimal complication according to the results obtained in this report.