Functional and Cosmetic Results of Fingertip Replantation

Matsuzaki, Hiroyuki; Yoshizu, Takae; Maki, Yutaka; Tsubokawa, Naoto

doi:10.1097/01.sap.0000137136.09890.18

Cited by 46 publications

(47 citation statements)

References 13 publications

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“…Clinical reports show that a fingertip replant could survive with only arterial repair and external bleeding by means of a fish-mouth incision made in the digital pulp. 13,37,38 This technique was also employed in this study to rescue several replants with venous thrombosis, however, this technique was not reliable for achieving the survival of replants with compromised venous outflow. Poor cold tolerance and atrophy of the fingertip most likely occur in the survived replants with poor circulation.…”

Section: Discussionmentioning

confidence: 98%

“…Clinically, the overall survival rates of fingertip replantations vary from 62.1 to 92% in literature. 19,20,37,38 The pursuit of a healthy vessel for vascular anastomosis often results in defects of the vascular vessels in replants. Traditionally, strategies for the release of anastomotic tension include bone shortening, rotation of neurovascular or vascular pedicles, 39 and interpositional vein No statistically significant differences were noted between the two groups in range of motion (t-test), cold intolerance rate, nail deformity rate, and pulp atrophy rate (Fisher's exact test) (all P > 0.05).…”

Section: Discussionmentioning

confidence: 99%

“…Thus, bone shortening possibly results in poor functional and cosmetic recovery in the replant. Although dissection of a vascular pedicle may preserve the length for vascular repair and some authors performed replantations by dissecting the vessels extensively and using the so-called central branch by transposition to gain the length for direct anastomosis, 20,37,[41][42][43] these methods showed limited reliability. In this series, we compared the survival rate, complications, functional and cosmetic outcomes between fingertip replantations with vein grafting and without vein grafting.…”

Section: Discussionmentioning

confidence: 99%

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Vein grafting in fingertip replantations

et al. 2009

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In this retrospective study, the survival rates of fingertip replantation with and without vein grafting were evaluated along with their postoperative functional and cosmetic results. One hundred twenty-one-fingertip amputations were performed in 103 patients between September 2002 and July 2007. Thirty-four amputated fingertips were replanted without vein grafting, while 87 amputated fingertips were replanted with vein grafting for arterial and/or venous repairs. The overall survival rates of the replantations with and without vein grafting were 90% (78/87) and 85% (29/34), respectively. The survival rates were 88% (36/41) with venous repair, 93% (25/27) with arterial repair, and 89% (17/19) with both. Nineteen patients without vein grafting and 48 patients with vein grafting had a follow-up period of more than one year. Good cosmetic and functional outcomes were observed in both groups of patients. The results show that vein grafting is a reliable technique in fingertip replantations, showing no significant difference (P > 0.05) in survival between those with and without vein grafting. Furthermore, no significant difference (P > 0.05) in survival was found between cases with vein grafts for arterial and/or venous repairs. In fingertip replantations with vein grafting, favorable functional and esthetic results can be achieved without sacrificing replantation survival.

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Section: Discussionmentioning

confidence: 98%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Vein grafting in fingertip replantations

et al. 2009

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“…[15][16][17] Japanese patients' satisfaction is generally attributed to maintaining digit length and salvaging the nail. 18,19 A focus on aesthetics over function in Japanese patients may be due to Confucian teachings that maintain that the body is a gift from one's parents and therefore must be safeguarded. Hence, if one begins life with a complete body, it is one's responsibility to see that it remains complete.…”

mentioning

confidence: 99%

Direct-to-Implant Single-Stage Immediate Breast Reconstruction with Acellular Dermal Matrix

Gdalevitch

Genoway

et al. 2014

Plastic &Amp; Reconstructive Surgery

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Purpose-Large geographic differences in utilization of a procedure draw into question its appropriate use. In Japan, replantation is commonly conducted for even very distal finger amputations. In the US, revision amputation is far more common. There has been no detailed investigation into the drivers of these differences.Methods-We created a survey to assess surgeons' experience with replantation, estimates of physical and functional outcomes, attitudes toward amputees, and preferences in several injury scenarios. The survey was distributed to members of the Finger Replantation and Amputation Multicenter (FRAM) Study and to hand surgeons making podium presentations at the Central Japanese Society for Surgery of the Hand Annual Meeting.Results-100% of both groups responded. There were no significant differences in experience with finger replantation. Japanese hand surgeons were significantly more likely to recommend replantation in all scenarios, despite 62% ranking function 6 months after replantation as "poor." Japanese surgeons rated the appearance of a hand with an amputated finger significantly poorer than American surgeons. Japanese surgeons were also significantly more likely to report stigmatization against finger amputees.Conclusion-There is no high level of evidence study comparing outcomes following replantation and revision amputation. The lack of evidence results in surgeons basing recommendations on personal preference. In this case, Japanese surgeons preferred replantation despite agreeing that functional outcomes were suboptimal. This may be because of Japanese cultural beliefs. Comparative effectiveness research, like that planned by the FRAM study, can help elucidate the appropriate utilization of finger replantation based on evidence.Corresponding author and reprint requests sent to: Kevin C Chung, MD, MS, Professor of Surgery, Section of Plastic Surgery, Assistant Dean for Faculty Affairs, University of Michigan Medical School, 2130 Taubman Center, 1500 W Medical Center Dr, Ann Arbor, MI 48109-0530, Phone: 734-615-3435, kecchung@umich.edu. Hand injuries pose a worldwide burden. Much of the world relies on manual labor such as farming and factory work for sustenance and income. In these cases, revision amputation, which allows for quicker return to work while largely maintaining function, is the preferred treatment. Despite more oversight by many countries in developing safety measure to protect workers, amputation of digits occurs frequently, even in highly developed countries such as the US and Japan. In these regions surgeons are engaged in intense microsurgical training and have access to advanced surgical technology and are able to replant amputated digits successfully. The use of this procedure is variable, however. In Japan and other parts of Asia, ever expanding indications for finger replantation mean the procedure is performed with increasing frequency. 3,4 In contrast, finger replantation is performed by a small fraction of hand surgeons at only 15% of American hospitals. 5,6...

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“…In past decades, continuing development of microsurgical techniques has made it possible to replant finger at any level of the amputation, even with fingertip amputation that are caused by degloving or ring avulsion injuries. [1][2][3][14][15][16][17] In multidigital injuries, microvascular finger fillet flaps were used to cover the defect of soft tissue or to reconstruct other digits by microvascular digit transposition, and good functional results were achieved. [18][19][20] The fingertip amputation is one of the most common injuries in hand.…”

Section: Discussionmentioning

confidence: 99%

Replantation of amputated finger composite tissues with microvascular anastomosis

et al. 2008

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Replantation of the partial amputated finger or the composite tissue in finger would achieve better functional and esthetic results than any reconstructive procedure. In this article, we report the results of microsurgical partial finger or composite tissue replantation at different anatomic sites of 24 fingers in 21 patients. Microvascular anastomosis was performed in all cases of replantation. For the digital palmar and lateral composite tissue defects, the proper palmar digital artery and volar or dorsal subcutaneous veins were repaired by end-to-end anastomoses. For the digital dorsal defects, the blood supply was reestablished by arterialization of a dorsal central vein in the replanted part with one of the proper palmar digital arteries. The average follow-up period was 12.3 months. Twenty-two of 24 fingers survived completely with good functional and esthetic results. Two replantations failed because of vascular complications. In conclusion, if the vascular vessels in amputations of partial finger and composite tissue of finger are suitable for anastomosis, a successful replantation of these parts with excellent functional and esthetic recovery can be achieved.

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Functional and Cosmetic Results of Fingertip Replantation

Cited by 46 publications

References 13 publications

Vein grafting in fingertip replantations

Vein grafting in fingertip replantations

Direct-to-Implant Single-Stage Immediate Breast Reconstruction with Acellular Dermal Matrix

Replantation of amputated finger composite tissues with microvascular anastomosis

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