title: Microvascular anastomoses in replanted fingers: do they stay open?
abstract: Replantation of fingers is a well established procedure following traumatic amputation. Several studies have documented the functional results of replanted digits. Studies have not documented the long-term (greater than 5 yrs) patency of the microvascular anastomosis in the replanted digit. Duplex imaging, a combination of B-mode ultrasound and bidirectional Doppler ultrasound has been shown to visualize vessels 1 mm in diameter. Color enhancement of the ultrasound image is now possible. We evaluated 18 patients with 24 replanted fingers to assess vascular patency. A minimum of five years follow-up was required for inclusion in the study group. Examination showed a patent anastomosis in every case and a Digital-Brachial Index within normal limits in 71% of the digits. Microvascular anastomoses in vessels as small as 1 mm in diameter remain open as long as 11 years following completion. The sophisticated techniques of color enhanced Duplex imaging makes long-term evaluation of these procedures possible in a non-invasive and accurate fashion. The use of such imaging modalities will have an important role in the evaluation of replanted digits and microvascular procedures in general.
authors.affiliation: Department of Hand Surgery, Walter Reed Army Medical Center, Washington, DC.
authors.forename: D M
authors.initials: DM
authors.lastname: Schmidt
authors.forename: M A
authors.initials: MA
authors.lastname: McClinton
mesh_terms: D000328:Adult; D000368:Aged; D000673:Amputation, Traumatic / Q000601:surgery*; D000714:Anastomosis, Surgical; D001794:Blood Pressure; D002196:Capillaries / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D005260:Female; D005383:Finger Injuries / Q000601:surgery*; D005385:Fingers / Q000098:blood supply* / Q000000981:diagnostic imaging; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D012039:Regional Blood Flow; D012092:Replantation; D013997:Time Factors; D014463:Ultrasonography; D014654:Vascular Patency