Vein grafting in fingertip replantations

Abstract

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.

Duration and cessation characteristics of heparinization after finger replantation: A retrospective analysis of outcomes

“…The absence of relationship between grafts and poor outcomes was maintained when subgroup analysis was performed on arterial versus venous complications. Other authors have demonstrated similar findings, with no effect of vein grafts on survival of digital replantation (Yan et al, ). High‐level evidence based on studies on the use of anticoagulation in finger replants with vascular grafts are lacking, but many advocate that some form of anticoagulation with heparin may be beneficial.…”

A Systematic Review of the Outcomes of Replantation of Distal Digital Amputation

“…Twelve studies included only cases in which a specific operative technique (vein graft, artery only, delayed venous repair etc.) was used 17, 20, 26, 28–30, 32, 34, 36–38, 40 . Five studies did not present the number of patients studied 11, 14, 18, 24, 25 , 6 studies did not present data about which digit was amputated 11, 18, 19, 24, 32, 37 , and 9 studies made no mention of the nature of injury that led to the amputation 11, 16, 18, 24–26, 30, 32, 37 .…”

Fingertip Replantation with the Use of a Long Vein Graft: Training Young Surgeons in a Feasible Technique to Maintain Optimal Results

“…This procedure was similar to the "pre-osteosynthesis vein graft technique" described by Ikeda et al 9 in 1994, but skeletal fixation was not applied in most cases, consistent with Sabapathy et al 10 The vein graft was long enough to reach the proximal phalanx, which is much longer than previously reported. 7,9 This long vein graft could usually be harvested from the dorsum of the foot, where the subcutaneous veins have various branches with sizable diameters that are adequate for grafting. The anastomosis between the artery in the amputated fingertip and the vein graft was first performed on the back table where the amputated fingertip and vein graft could be placed under a microscope and held in the optimal positions for anastomosis (►Fig.…”