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Impact of the Number of Vein Repair in Short-Term Digital Replantation Survival Rate
Johnny I. Efanov; Demitrios Rizis; Genevieve Landes; Joseph Bou-Merhi; Patrick G. Harris; Alain M. Danino
Plastic Surgery, Montreal University Hospital, Montreal, QC, Canada

Background: Venous congestion/insufficiency plays a major role in failure of digital replantation. Despite acceptable salvage rates with postoperative leeching or anticoagulation, operative technique remains the most important predictor of success. However, there are no indications in the literature on the benefit of micro-anastomosing single versus multiple veins in digital replantation.

Methods: A retrospective review of all patients treated at our provincial Replantation Center for complete amputation of digits from January 2011 to April 2013 was conducted. Demographic data, mechanism and level of trauma, intraoperative details, including venous repair states, and postoperative complications were collected and tabulated. The analyzed endpoint was finger survival rate at patient discharge in 3 groups: fingers with multiple vein anastomoses, fingers with only one vein anastomosis and fingers without any vein repairs. Proportions were compared using v2 tests/Fisher’s exact tests ; pvalue < 0.05 was considered significant.

Results: 72 patients with complete digital amputation via clean-cut (82%), avulsion (13%) or crush (5%) injuries were operated from Jan 2011 to Apr 2013. In total, 101 fingers were replanted, of which 27 fingers (26.7%) failed before hospital discharge, due to venous insufficiency/congestion/thrombosis (n=21, 78% of failures) versus arterial causes (n=6, 22%). There were 25 digits with two or more veins repaired (group 1), 62 with only one vein (group 2) and 14 without vein repair (group 3). In group 1, only 2 digits from 25 (8%) did not survive the replantation, both of which having been recognized intraoperatively with low flow, and only one failing later because of venous congestion. Group 2 had 18 replantation failures, including 15 from venous causes (24%) representing a 1.27-fold (95% CI, 1.08–1.49) increased relative risk of failure when compared to group 1 (p=0.0042). Similarly, 50% of digits from group 3 did not survive replantation, 5 (36%) due to venous causes, giving a 1.49-fold (95% CI, 1.0025–2.2246) increased likelihood of failure in comparison to group 1 (p=0.0486). Interestingly, there was no significant difference between having only one vein repaired versus none (RR 1.1792, 95% CI, 0.78-1.79). Furthermore, 4 of the total 87 digits with venous repair required a bypass graft, with only one failing postoperatively.

Conclusion: Efforts toward favoring two-vein repair over single-vein repair or no veins lead to better surgical survival of the replanted digits. Further questioning remains about the role of bypass or arterial derivation when there is no available distal vein for a second reanastomosis.


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