Although vascular thrombosis following digital replantation is most likely to occur within the first 72 hours, a significant risk still exists up to 2 weeks after surgery. We discuss circulatory insufficiency after digital replantation based on 13 patients and 15 replantations over a 5-year period. The level of amputation included one digit in zone I, five digits in zone II, seven digits in zone III, and two digits in zone IV. The types of injury included clean-cut (one case), crush (three cases), compression (six cases), and avulsed (three cases). Arterial thrombosis occurred within the first 7-111 hours, and venous thrombosis within the first 5-115 hours. This difference was not significant (P>0.05). Approximately 53% of the circulatory insufficiencies occurred between 3:00 and 7:00 in the morning. Thrombosis in smokers (eight patients) occurred within the first 5-115 hours, and thrombosis in nonsmokers (five patients) occurred within the first 6-68 hours. A strong association was observed between smoking and the risk of late circulatory insufficiency. Our findings suggest that close monitoring for 72 hours following replantation is important and probably sufficient; however, smokers should be monitored longer than nonsmokers.
