In recent year, reattachment of the amputated fingers has been common experimental and clinical procedures. In replantation, the microsurgical anastomosis of arteries and veins is necessary which is supplemented by the other procedures needed to reestablish the digit as a functional element-nerve coaptation, tendon repair, skeletal fixation and other reconstructive procedures as needed.
The essential elements for the successful outcomes are: the surgery completed as soon as possible after injury, cooling of the severed digits until surgery, careful postoperative regimens including antibiotics, anticoagulants and intervention when the signs of failure of vascuslar inadequacy arise, besides good surgical techniques and measures of rehabilitation.
Authors report the replantation cases of 11 amputated digits in 9 patients. among the 11 digits, complete amputation was in 7 digits and incomplete amputation was in 4 digits.
Seven of them were guillotine type injury and the other four were local crush one. They were composed of 3 index, 3 middle, 3 ring, 1 thumb and 1 little fingers. The operations were performed under the axillary nerve block. In most cases one atery, two veins and both digital nerves were repaired through operating microscope(6-10) with bone fixations and tendon repairs. Anticoagulants were used for 1-2 weeks postoperatively.
The success rate of our 11 digital replantations was 73%(8digits) and that of failure was 27%(3 digits).
Non-union of the digital bone developed in 2 cases which were satisfactorily treated with cancellous iliac bone grafts later. considerable postoperative wound bleeding were noted in 2 cases. One case was controlled with compressive dressing and the other was electrocoagulated resulting unfortunate thrombosis of the anatomosed artery at the 5th postoperative day.
The clinical courses were relatively unevenful in the successful cases and the sensations were almost recovered and showed satisfactory ranges of motion in most of the cases.
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