Fingertip replantation (zone I) without venous anastomosis: clinical experience and outcome analysis.
OBJECTIVE
The purpose of this study was to report our experience of fingertip replantation without venous anastomosis using alternate method to counter post-operative venous congestion.


METHODS
30 Patients (18 men and 12 women) with 30 fingertip amputations (Tamai zone I) were treated with artery-only anastomosis fingertip replantation between March 2010 and July 2014. Postoperative venous outflow was maintained by allowing bleeding through wound gaps combined with topical (12500u:250mlNS) and systemic (4000 IU SC once daily) heparin. The outcomes of replantation were evaluated using standard evaluating systems.


RESULTS
The average duration of hospital stay was 10 days (range 7-14 days). Twenty-eight (93 %) replanted fingertips survived. Five replanted fingertip experienced postoperative vascular crisis. The estimated post-operative blood loss was about 200-450 ml (mean, 292 ml). Follow-up period ranged from 12 to 24 months (average, 18 months). At final follow-up examinations, the average value of static two point discrimination test was 5.6 mm (range 3-9 mm) and Semmes-Weinstein monofilament test was 3.35 g (range 2.83-4.56 g). The mean range of motion of distal interphalangeal joint was 65.2° (range 0-90°) and all patients returned to their work within 7-18 weeks (average, 11 weeks).


CONCLUSIONS
Artery-only fingertip replantation can provide satisfactory cosmetic and functional results. Adequate venous outflow can be obtained by allowing minimal external bleeding through wound gaps combined with topical and systemic heparin.
Department of Hand and Foot Surgery, Subei People's Hospital, Clinical Medical College of Yangzhou University, Yangzhou City, 225001 Jiangsu Province People's Republic of China.|College of Medicine, Yangzhou University, 11th Huaihai Road, Yangzhou City, 225009 Jiangsu Province People's Republic of China.
An-Shi
AS
Huan
College of Medicine, Yangzhou University, 11th Huaihai Road, Yangzhou City, 225009 Jiangsu Province People's Republic of China.
Subhash
S
Regmi
Department of Hand and Foot Surgery, Subei People's Hospital, Clinical Medical College of Yangzhou University, Yangzhou City, 225001 Jiangsu Province People's Republic of China.
Jia-Xiang
JX
Gu
Department of Hand and Foot Surgery, Subei People's Hospital, Clinical Medical College of Yangzhou University, Yangzhou City, 225001 Jiangsu Province People's Republic of China.
Hong-Jun
HJ
Liu
Department of Hand and Foot Surgery, Subei People's Hospital, Clinical Medical College of Yangzhou University, Yangzhou City, 225001 Jiangsu Province People's Republic of China.
Wen-Zhong
WZ
Zhang
Artery-only anastomosis; Fingertip amputation; Replantation; Tamai zone I