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Finger Tip Replantation-Ultramicrosurgery Technique and its Postoperative Therapy
Hiroyuki Gotani, MD, PhD
Hand Surgery, Osaka Trauma and Microsurgery Center, Osaka, Japan

Introduction: Microsurgical replantation was applied to finger tip amputations of Zone 1(55 fingers) and of Zone 2 (90 fingers). Technically difficult, but excellent appearance and function were obtained.

Materials and methods: 19 fingers were classified as clean cut amputation, 78 were classified as local crush amputation and 48 were classified crush amputation. 12 children (3 to 9 years old) were included in this series. In order to replant these cases successfully, precise comprehension of digital anatomy and skilled microsurgical technique are requisite. Especially in zone-1 amputations, diameter of vessels are less than 0.5mm. The distal transverse palmar arch (DTPA) exist between zone-1and zone-2 in the distal part of the finger. Normally, in the palmar side of the distal phalanx, fine artery exist distal to the DTPA. This artery has potential to maintain enough blood supply for the survival of amputated part. After an anastomosis of this artery, in order to overcome congestion, fish mouth incision was made in the finger tip to allow blood-letting.In 6 cases, delayed venous anastmosis (Koshima) were performed to avoid venous congestion.

Results: In our series, 18 out of 21 amputated thumbs were successfully replanted(86%) including partial necrosis, 103 out of 124 amputated other fingers were successfully (83%) replanted including partial necrosis. 101 fingers out of 145 were evaluated by S-W test postoperatively. 50 fingers showed normal sensation, 23 showed diminished light touch, 15 showed diminished protective sensation and 13 showed loss of protective sensation. In 74 cases, patients could pinch magazine using their replanted finger.

Discussion: Because post operative function and appearance are excellent, we should make positive efforts to replant these cases with the collaboration of medical staffs.

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