Fingertip Replantation Without Venous Anastomosis

Abstract

This study showed that a protocol that promotes controlled bleeding from the fingertip is essential to achieve consistent high success rates in fingertip replantation. The protocol is safe and reliable, as it avoids the use of medical leeches and the removal of nail plate from the replanted finger. However, full informed patient consent must include the potential need for transfusion and extended hospital stay.

Fingertip Replantation Without and With Palmar Venous Anastomosis

“…Frequent dressing changes and close monitoring are necessary because of the potential risk of uncontrolled bleeding or clotting. 14,16,17 Medical leeches also have risk of infection with Aeromonas, Pseudomonas, and Staphylococcus in 7% to 20% of cases. 18 There are a few data about the success rates of venocutaneous fistulas.…”

Tamai zone I fingertip replantation: Is external bleeding obligatory for survival of artery anastomosis‐only replanted digits?

“…When venous anastomosis is not feasible, procedures for venous drainage to relieve congestion will be considered: arteriovenous fistula, venocutaneous fistula, and external bleeding methods. There are a variety of external bleeding methods: leech therapy, or externally applied, subcutaneous, or systemic heparinization combined with fingertip, nail bed, and paraungual incision . The average external bleeding period is approximately 7 days .…”

“…Leeches have been also used to relieve venous congestion . Usually the period of bleeding is approximately 7 (6–7.6) days . The bleeding amount is unpredictable and may be profound.…”

Leech Therapy in Nearly Total Amputation of Fingers Without Vascular Repair; A Case Report

“…Chen et al proposed controlled bleeding from the fingertip with leech therapy in fingertip replantation (11). For this goal, various methods such as paraungual incision, and distal fish-mouth incision are used (12, 13).…”