A Comparative Study of Digital Nerve and Digital Arterial Repairs Performed Using Running versus Interrupted Suture Techniques in Finger Replantations

Abstract

BACKGROUND:The present study aimed to retrospectively analyze replantations and compared the success rates of different suturing techniques. METHODS:The data of 54 patients who underwent 82 finger replantations between January 2016 and April 2020 were retrospectively analyzed. Patients who underwent traumatic total finger amputations were included in the study. Arteries were repaired with two techniques, the simple running suture technique and the simple interrupted suture technique. Demographic patient data, comorbidities, operative data, post-operative care, the length of hospital stay, mechanism of injury, and site of injury were recorded. The groups were statistically analyzed. Functional outcomes were evaluated according to the Quick DASH score. RESULTS:A total 54 patients with a mean age of 32.5±18.4 (range 1-75) who underwent finger replantation were included in the study. The mean duration of follow-up was 30.9±16.1 months. The mechanism of injury was guillotine-style injury in 29 (35.4%) fingers, avulsion injury in 15 (18.3%) fingers, and crush injury in 38 (46.3%) fingers. Forty-six fingers were repaired using a simple running suture technique, and 36 fingers were repaired using a simple interrupted suture technique. There was no statistically significant difference in terms of failure between the suture techniques (p=0.569). Further, although there was no statistically significant difference in Quick DASH scores according to the type of trauma in the simple running suture technique group (p=0.109), a comparison could not be made within simple interrupted suture technique group because of the small sample size. There was no statistically significant difference in failure rates between cases with an ischemia duration of <6 h and those with ischemia duration of 6-12 h (p>0.05). No statistically significant difference was found between the groups according to age, body mass index, arterial hypertension, or diabetes mellitus (p>0.05). Statistically significant differences were found in univariate analysis according to surgery time per digit, smokers, or vein repair (p<0.05). In total, 65 (79.3%) out of 82 finger replantations were successful. A total of 17 out of 30 fingers that could not undergo venous repair survived because of treatment with medicinal leeches. CONCLUSION:Finger replantation is a difficult-to-perform surgical procedure requiring consideration of the surgical indications and the presence of an experienced surgical team. Regardless of the suture technique in finger amputations, performing venous anastomosis after arterial anastomosis is essential to restore circulation.

Amputated Digit Replantations

“…5). 4,12,19,25,39,42–47,49–52,54–56,58,59,61,64,67,69,71,72 As expected, clean-cut injuries were associated with significantly higher odds of survival than crush injuries (Fig. 5A; OR = 1.84; 95% CI = 1.13 to 2.99; P = 0.01).…”

“…Our meta-analysis included 19 studies incorporating data on replanted digit survival based on the Tamai classification for the zone of amputation injury 19,25,39,41,42,44,45,49,50,54,58,61,63–67,70,71 . When compared to Zone I, only Zone IV injuries had significantly higher odds of replantation survival in our meta-analysis (Fig.…”

“…In our literature review, we came across six additional outcomes discussed in the studies that were included in our meta-analysis: age (adult/child), 4,12,25,39,44–46,51,52,55,57,58,61,64,66,69,72 sex (male/female), 4,12,19,39,42–44,46,47,49–51,57–61,64,66,72 smoking status (smoker/nonsmoker), 4,12,25,39,43,44,50,53,56,59,69 injured hand (right/left), 41,46,47,51,52,55,58–60,64,66,72 replant magnitude (incomplete/complete), 4,30,40,41,48,49,58,74 and injured finger (thumb/index/middle/ring/little) 12,39,41,42,45–47,49,51,52,54–56,58,59,61,64,66,72,74 (Table 3). For these outcomes, only smoking status demonstrated a statistically significant difference in replanted digit survival, with smokers having 50% lower odds of survival when compared to patients who did not smoke (Tables 3, 4; OR = 0.50; 95% CI = 0.39 to 0.63; P < 0.001).…”

“…3). 4,25,[41][42][43][44][45] The cumulative survival rate was higher in early cohort (90.0%) versus the late cohort (87.9%), and this difference was insignificant (P = 0.17). Our calculated odds of survival in the early (0-6 hours) replantation group were over 40% greater than the later (6-12 hours) replantation group (OR = 1.45; 95% CI = 1.05 to 2.00; P = 0.02).…”

“…In our literature review, we came across six additional outcomes discussed in the studies that were included in our meta-analysis: age (adult/child), 4,12,25,39,[44][45][46]51,52,55,57,58,61,64,66,69,72 sex (male/female), 4,12,19,39,[42][43][44]46,47,[49][50][51][57][58][59][60][61]64,66,72 smoking status (smoker/nonsmoker), 4,12,25,39,43,44,50,53,56,59,69 injured hand (right/left), 41,46,47,…”