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Purpose: This study aimed to compare survival rates and risk factors of replantation failures using an interposition vein graft in fingertip amputations with segmental vessel defects with those using simple end-to-end anastomosis in amputations., Patients and Methods: Between 2004 and 2015, 776 (647 males and 129 females) with single Zone I or II amputations of digits underwent replantation. Among these, simple end-to-end anastomosis was performed in 698 replantations, while interposition vein grafts were used for either arterial or venous repair or both in 78 amputated fingertips. The survival rate was compared between the groups. Logistic regression analysis was performed to identify risk factors predicting replantation failure in all study subjects., Results: Among 776 replantations, 713 (91.9%) survived. At latest follow-up, of 698 cases in the simple anastomosis group, 650 (93.1%) survived; of 78 cases in the vein graft group, 63 (80.8%) survived (p > .001). Logistic regression analysis revealed that avulsion type (odds ratio [OR] 3.121; 95% confidence interval [CI], 1.211-8.064; p = .018) and zone II amputation (OR, 2.370; 95% CI, 1.382-4.065; p = .002) were significant risk factors for replantation failure., Conclusion: This study demonstrates that the survival rate (80.8%) of the vein graft in fingertip amputation with segmental vessel defects was shown to be a possible option to increase the survival rates in case with segmental vessel defects where simple anastomosis could not be performed. However, avulsion type and zone II amputation are important risk factors of replantation failures., (© 2020 Wiley Periodicals, Inc.)

Background: Although thenar flap for single fingertip amputation is a common and popular surgical technique, double thenar flap technique for patients with two fingertip amputations has rarely been reported in the literature. The purpose of this case-control study was to introduce the double thenar technique and compare the clinical outcomes between single thenar flap and double thenar flap surgical treatments., Methods: From January 2005 to December 2014, 92 patients with single fingertip amputations were treated with thenar flap (Group I) and 28 patients with two fingertip amputations were treated with double thenar flap (Group II). These 120 patients were followed-up for a minimum of 12 months postoperatively. At the latest follow-up, the two groups were assessed for pain, cold intolerance in the reconstructed finger, functional outcomes by Chen's criteria, and subjective patient satisfaction., Results: At the final follow-up, all flaps in both groups had survived. No flap failure occurred. There was no significant difference in cold intolerance (p=0.783), donor site pain (p=0.728), fingertip pain (p=1.000), or paresthesia (p=0.514) between the two groups. A total of 100 (83.3%) patients were completely or fairly satisfied. There was no significant difference in satisfaction between the two groups (p=0.801). According to the Chen criteria, 102 (85%) patients had excellent or good results., Conclusion: This study demonstrated that the double thenar flap technique used for patients with two fingertip amputations produced complete survival with functional outcomes comparable to those of the single thenar flap technique at the last follow-up., (Copyright © 2016 Elsevier Ltd. All rights reserved.)

Background: The purpose of this study was to evaluate outcomes and risk factors for failure after digital replantation in elderly patients, with a special focus on the effect of patient age on replantation success., Methods: Replantation patients older than 60 years were analyzed thoroughly to characterize outcomes and risk factors for failure in older patients. Survival rates of all age groups older than 20 years were then analyzed to determine the specific effect of patient age on replantation success. The clinical and functional outcomes and risk factors for failure were evaluated at a minimum 1-year follow-up., Results: Among 161 patients older than 60 years, 189 of 208 replanted digits survived completely (91 percent survival). The only factors predictive of failure were mechanism of injury and age. Excellent or good results (Chen criteria) were obtained in 58 percent of patients, and 94 percent of patients were completely or fairly satisfied. Analysis of all age groups older than 20 (1648 patients) demonstrated a significant increase in failure rate in those aged 70 years and older., Conclusions: The authors demonstrated a high rate of digit replantation success in elderly patients. However, 70 years and older was identified as an important factor predicting replantation failure., Clinical Question/level of Evidence: Risk, III.

Purpose: Replantation of amputations separated by more than four digits is challenging microsurgery because of the technical demands and long operation time. The purpose of this report was to present the clinical and functional outcomes in patients with amputations of four or five digits using a simultaneous replantation technique., Patients and Methods: Among the 43 patients who visited our institution due to amputation of four or five digits from 2004 to 2013, 35 patients (28 males and seven females) underwent simultaneous replantation of four or five digits. The age range of the patients was 25-64 years (mean, 40.6 years). Simultaneous replantation technique included that bone was fixed and flexor tendons were repaired first and then digital vessels and nerves were simultaneously anastomosed for all amputated digits. The clinical and functional outcomes were evaluated at a minimum 1-year follow-up., Results: Ischemic time was 150-510 min. Mean operation time was 313.2 min. In total, 127 of the 145 (87.5%) digits remained viable survived 2-weeks postoperatively, and four patients (16 digits) were lost to follow up. Of the 31 patients (129 digits), 19 (61.3%) had excellent and good outcomes using the criteria of Chen, and 21 patients (71%) were satisfied completely. Mean grip strength of the injured hand was 67% at the last follow-up., Conclusion: The results from this series of cases showed that the simultaneous replantation technique for four or five digit amputations may provide an alternative method to shorten surgical time, reduce complication rates, and enhance high survival rate., (© 2015 Wiley Periodicals, Inc.)