Survival after digit replantation and revascularization is not affected by the use of grafts during arterial repair
Z-Hye Lee, MD; Christopher Klifto, MD; Joshua Cohen, BS; Michael T. Milone, MD; Vishal D Thanik, MD; Jacques H. Hacquebord, MD
NYU Langone Medical Center, New York, NY
Background:
Primary arterial repair in digit revascularization and replantation is sometimes not feasible due to a large zone of injury. To avoid excessive digit shortening, interpositional grafts can be utilized to reconstruct the artery in such cases. The rates of digit survival after revascularization and replantation in primary repair vs. repair with a graft are not well elucidated.
Methods:
A retrospective review of all patients at a public urban teaching hospital from 2007 to 2015 that required revascularization and/or replantation of one or more digits were performed. Demographic data, preoperative factors and intraoperative details were collected. Survival of the digits was the primary outcome measure.
Results:
126 patients were identified with 171 affected digits. There were a total of 53 digits that underwent replantation and 118 digits that underwent revascularization. Of the 118 revascularizations, a graft was used to repair the artery in 50% (n=59) of digits. Digit survival with use of a graft for arterial repair vs. primary repair after revascularization was equal (91.5% in both groups). Of the 53 replantations, a graft was used to repair the artery in 49.0% (n=26) of the digits. The average graft length was 4.4 cm (range 0.5-12). There was no statistical difference in digit survival with use of a graft for arterial repair vs. primary repair after replantation (46.2% vs. 48.1%, p = 1.00). The most common source of graft was a vein from the forearm & wrist (47.7%, n = 41) followed by vein harvested from the dorsal foot (47.1%, n = 40). There were 5 digits that utilized an artery from another amputated digit as a spare part. The site of graft did not have any effect on digit survival (p=0.971). A graft was more likely to be used in crush and avulsion injuries (66.7%) compared to laceration injuries (44.2%) with RR 1.51 (p=0.01).
Conclusion:
Grafts were utilized for arterial repairs in nearly half of all devascularized digits. There was no statistical difference in the digit survival rate for digits that were repaired primarily versus those repaired using a graft. The need for a graft in a large zone of injury should not be considered a contraindication to performing revascularization or replantation. Furthermore, hand surgeons should have a low threshold for using grafts especially in crush or avulsion injuries.
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