The fate of microanastomosed digital arteries after successful replantation

Abstract

Background: Some replanted fingers show occlusion of the anastomosed arteries, although they are successfully replanted and ultimately survive. They seem to be perfused by the soft-tissue vasculature and not by the anastomosed arteries. Therefore, this study was designed to investigate the fate of microanastomosed digital arteries after successful replantation.

Methods: The authors performed a prospective study of 75 fingers of 62 cooperative patients who had undergone successful replantation from June of 2000 to December of 2001 at Korea University Guro Hospital. We used Dopplex to screen anastomosed artery patency; thereafter, angiographic studies were also performed to confirm the Dopplex results in 18 patients. The patency of vascular pedicles was analyzed according to several parameters, namely, the cause, type, and level of injury; the number of repaired veins; and the use of an interpositional vein graft for arterial repair.

Results: The pulsation was not heard by Dopplex in 37 percent of anastomosed arteries after an average of 15 postoperative days. Angiographic results coincided with Dopplex results in all cases. Guillotine injuries had a pedicle occlusion rate of 8 percent, whereas crush injuries had a pedicle occlusion rate of 43 percent (p < 0.05). Regarding the level of injury, a statistically significant difference was only found between groups with a distal phalanx level of injury and those with a proximal phalanx level of injury (p < 0.05). Other parameters showed no significant differences in patency.

Conclusions: We conclude that 37 percent of microanastomosed digital arteries of replanted fingers are occluded after replantation. Distinctively, amputation at the distal phalanx by crush injury increases the possibility of occlusion of microanastomosed digital arteries.