Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2020 Jul;15(4):488-494.
doi: 10.1177/1558944719828002. Epub 2019 Feb 14.

Relationships Between Vein Repairs, Postoperative Transfusions, and Survival in Single Digit Replantation

Michael T Milone  1 , Christopher S Klifto  2 , Z-Hye Lee  3 , Vishal Thanik  3 , Jacques H Hacquebord  1   3
Affiliations

Relationships Between Vein Repairs, Postoperative Transfusions, and Survival in Single Digit Replantation

Michael T Milone et al. Hand (N Y). 2020 Jul.

Abstract

Background: The general teaching is that increased number of vein repairs in digit replantation leads to improved venous outflow, resulting in lower need for iatrogenic bleeding, lower postoperative transfusion requirements, and better survival rates. The purpose of this study was to determine whether the traditional teaching that emphasizes the repair of multiple veins per arterial anastomosis results in superior survival rates. Methods: A retrospective review of a single urban replant center's single-digit replants distal to the mid-metacarpal level in adult patients from 2007 to 2017 was performed. Data on patient demographics, mechanism and level of injury, veins repaired, iatrogenic bleeding, postoperative transfusions, and replant survival were obtained. Results: There were a total of 54 single-digit replants. The most common mechanism was lacerations (N = 38), and the most common injury level was at the proximal phalanx (N = 21). All digits were replanted with a single arterial anastomosis-44% via grafting. In all, 0 to 3 veins were repaired per digit (mean = 1.5 veins). The mean transfusion requirement was 1.7 units. The survival rate was 50%. Digits with 1 or 2 veins repaired had lower transfusion requirements (1.1-1.3 units) and higher survival rates (56%-61%) compared with those replanted with 0 or 3 veins repaired (2.9-3.5 transfused units, 25%-29% survival). There were no differences between those digits replanted with either 1 or 2 veins repaired for transfusion requirements or survival. Conclusions: More veins repaired do not necessarily improve survival or possibly venous outflow, calling into question the traditional teaching that 2 veins should be repaired for every arterial anastomosis.

Keywords: finger replantation; microsurgery; survival; venous anastomosis.

PubMed Disclaimer

Conflict of interest statement

Declaration of Conflicting Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
Length of stay and survival versus transfusion groups.
Figure 2.
Figure 2.
Transfusions and survival versus veins repaired.
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

References

    1. Fufa D, Calfee R, Wall L, et al. Digit replantation: experience of two U.S. academic level-I trauma centers. J Bone Joint Surg Am. 2013;95(23):2127-2134. - PubMed
    1. Sebastin SJ, Chung KC. A systematic review of the outcomes of replantation of distal digital amputation. Plast Reconstr Surg. 2011;128(3):723-737. - PMC - PubMed
    1. Waikakul S, Sakkarnkosol S, Vanadurongwan V, et al. Results of 1018 digital replantations in 552 patients. Injury. 2000;31(1):33-40. - PubMed
    1. Hattori Y, Doi K, Ikeda K, et al. Significance of venous anastomosis in fingertip replantation. Plast Reconstr Surg. 2003;111(3):1151-1158. - PubMed
    1. Efanov JI, Rizis D, Landes G, et al. Impact of the number of veins repaired in short-term digital replantation survival rate. J Plast Reconstr Aesthet Surg. 2016;69(5):640-645. - PubMed