title: Experience with distal finger replantation: a 20-year retrospective study from a major trauma center.
abstract: OBJECTIVE
  More than 40 years has passed since the first successfu0l replantation and thousands of fingers have been salvaged. We present our experience with distal finger replantation during 20 years of surgery. From 1990 to 2010, 420 replantations were performed; 64 of 420 cases were distal finger replantations. We discuss the indications, techniques, and outcomes of these difficult cases.
  
  
  METHODS
  The records of 64 patients were reviewed and the demographics, methods of replantation, success rates, and complications were evaluated. Bone shortening was performed and fixation method in this zone was mostly pin fixation. The "Bench Technique" for the amputated part consisted of preparing the artery, vein, and nerve. In zones 1 and 2a, the veins are volar and when incising the skin for dissection, utmost care was taken to save the volar delicate veins and prepare them for outflow. When there was no vein found, dissection was toward finding 2 arteries, 1 for inflow and 1 for outflow. Medicinal leeches were used during the first 10 years. Chemical leeching was used thereafter.
  
  
  RESULTS
  Our patients were mostly young male workers and from the industrial sector. Our success rate of 87% was similar to the current literature. The overall complication rate from minor wound infection was 35% and total finger loss was 13%. Medicinal leeches had minimal satisfactory results. Chemical leeching was more effective.
  
  
  CONCLUSIONS
  Our 20-year experience with distal finger replantation showed a success rate of 87%. On account of cultural beliefs amputation is not tolerated well in Eastern cultures. Thus, a high rate of single finger replantations is seen. The success rate is similar to that of the literature and cosmetic results are far superior to replantation in other zones.
authors.affiliation: Department of Surgery, Iran University of Medical Sciences, Tehran, Iran.
authors.forename: Shahram
authors.initials: S
authors.lastname: Nazerani
authors.forename: Mohammad Hosein Kalantar
authors.initials: MH
authors.lastname: Motamedi
authors.forename: Mohamad Reza
authors.initials: MR
authors.lastname: Ebadi
authors.forename: Tara
authors.initials: T
authors.lastname: Nazerani
authors.forename: Bardia
authors.initials: B
authors.lastname: Bidarmaghz
mesh_terms: D000328:Adult; D000673:Amputation, Traumatic / Q000601:surgery*; D000714:Anastomosis, Surgical; D000818:Animals; D000925:Anticoagulants / Q000627:therapeutic use; D001241:Aspirin / Q000627:therapeutic use; D004176:Dipyridamole / Q000627:therapeutic use; D005260:Female; D005385:Fingers / Q000098:blood supply / Q000601:surgery*; D006495:Heparin, Low-Molecular-Weight / Q000627:therapeutic use; D006801:Humans; D024763:Leeching; D007902:Length of Stay; D008297:Male; D008853:Microscopy; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D011182:Postoperative Care; D011183:Postoperative Complications; D012092:Replantation; D012189:Retrospective Studies; D014193:Trauma Centers
chemical_list: D000925:Anticoagulants; D006495:Heparin, Low-Molecular-Weight; D010975:Platelet Aggregation Inhibitors; D004176:Dipyridamole; D001241:Aspirin