AAHS - Variable Factors affecting the Success in the Distal Digit Replantation

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Variable Factors affecting the Success in the Distal Digit Replantation
Young Woo Kim, MD, PhD
W Hoapital, Daegu, Korea

Purpose: This study was aimed to analyze the variable factors affecting the success in the distal digit replantation and the usefulness and application of salvage external bleeding technique in case of venous congestion.
Methods: We conducted a retrospective review of 423 distal phalanx replantations performed from January, 2010 to July, 2015. Charts were reviewed about factors affecting the success of replantation, age, sex, mechanism of injury, level of amputation, surgical expertness of surgeon, vein repair or not. We also compared average blood transfusion amount and the hemoglobin level change during and 1 week after operation between vein repaired group and external bleeding group.
Results: The overall survival rate was 85.5% (362 of 423). Failure rate of the male group was lower than the female group. The success rate of the aged patient group (more than 60 years old) was also high(86.7%).

In the type of injury, a crushing injury was most common cause(56%). The success rate of a crushing type was 84.9%, and they showed no difference. In the level of injury, amputation of distal phalanx was most frequently occurred at Ishikawa zone 2 (43.3%), the success rate was showed no statistically difference between each level of injury. All zone I group was treated by external bleeding technique and vein repaired was performed in zone 2 only 3.3%(6/183) and in 56.5% of zone 3 injuries and in 80.4% of zone 4 injuries. All cases of vein repaired group in zone 2 and 3 were survived. But the failure rate of external bleeding group at zone 3 and 4 was statistically high. Within 7days external bleeding we could overcome the venous congestion. During external bleeding procedure, the hemoglobin level was decreased 3.02 g/dL, and only 24.6% patients needed blood transfusion, average 3.35 pints. The success rate of distal phalanx replantation was very low within one-year group(53.5%), and two-year group success rate was 84.7%, and more than three-year group was 93.5% respectively.
Conclusions: This retrospective study shows that a high rate of survival can be achieved after digital phalanx replantation. In addition, during external bleeding procedure, the need for blood transfusion is lower than previous studies and expectation. But In Ishikawa zone 3,4 injuries, vein repair was more reliable method for success of replantation. The sex and a surgical expertness of surgeon was important factor for the success of replantation.

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