title: [Acute vascular disorder as a complication of replantation and revascularization of the digital area].
abstract: This study on vascular complications in digital replantation and revascularization covers the six-year experience of a universitary replantation center. The material comprises 143 patients with 67 replantations and 137 revascularizations. Inadequate circulation was observed in 21.6% of the cases, or 17.6% of the digits. In digital replants, during or following the initial surgery, significant vascular complications were encountered in 28 (42%) of the replanted thumbs and fingers. Of these, seven digits (10.4%) presented with irreparable vascular damage and were amputated without salvage attempts. Single or repeated microvascular revisions saved 13 (two thirds) of the remaining digits. The survival rate of this group was thus raised to 78%. In digital revascularization, the vascular complication rate was much lower. In 137 digits, eight developed complications (6%). One of these was accepted as a failure; of seven reinterventions, five proved successful. The over-all survival rate was 98% in this group. To the factors known to determine survival following replantation and revascularization, those governing the ability to offset vascular complications must be added. In this respect, the analysis of our data revealed additional statistically significant prognostic elements: the decision for or against surgical reintervention, the location of the thrombosis relative to the arterial or venous side, the type of injury and the timing of revisional surgery. Other parameters, such as the age of the patient, the experience of the surgeon, or the type of initial vascular reconstruction were not statistically relevant. In our experience, repeated attempts at microvascular salvage in face of circulatory complications of digital replantations or revascularizations are worthwhile.
authors.affiliation: Handchirurgischen Abteilung der Universität, Inselspital, Bern.
authors.forename: M
authors.initials: M
authors.lastname: Sturzenegger
authors.forename: U
authors.initials: U
authors.lastname: Büchler
mesh_terms: D000293:Adolescent; D000328:Adult; D000673:Amputation, Traumatic / Q000601:surgery*; D001158:Arteries / Q000601:surgery; D002648:Child; D002675:Child, Preschool; D005260:Female; D005383:Finger Injuries / Q000601:surgery*; D005385:Fingers / Q000098:blood supply*; D005500:Follow-Up Studies; D006801:Humans; D007511:Ischemia / Q000209:etiology*; D008297:Male; D008866:Microsurgery / Q000379:methods*; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology*; D012086:Reoperation; D012092:Replantation / Q000379:methods*; D013933:Thumb / Q000098:blood supply* / Q000293:injuries*; D014680:Veins / Q000601:surgery; D014689:Venous Insufficiency / Q000209:etiology*
vernacular_title: Akute Durchblutungsstörungen als Komplikationen von Replantationen und Revaskularisationen im Digitalbereich.