30 巻 (2017) 1 号 p. 1-7
Vascular reconstruction is an absolutely critical step in finger replantation. The purpose of this study was to assess the success rate of replantation surgery in our institution, where the surgeon basically applied vein grafts for vascular reconstruction intraoperatively and continuous intravenous administration of heparin postoperatively. We retrospectively reviewed the records of patients undergoing digital replantation surgery in our institution from May 2011 to April 2014. Twenty-one patients and 27 digits exhibiting complete or incomplete amputation, accompanying arterial and/or venous disorder, were included in the study. Their injury mechanisms were 10 blunt cuts, 5 crush injuries, and 6 avulsion injuries. We interposed vein grafts in 40 out of 41 arterial reconstructions and 23 out of 26 venous reconstructions at replantation surgeries, and continuously administered heparin intravenously for 2 weeks postoperatively. The success rate was 92.6% ( 25 digits survived and 2 were lost ). Vascular patency after replantation surgery presumably depends on two factors ; technique of vascular anastomosis and damage of vascular endothelium in the replanted finger. Endothelial damage cannot be managed by surgical manipulation, and should be left to recover spontaneously. To minimize the effects of posttraumatic endothelial damage on vascular patency, it is recommended to replace the possibly damaged parts of digital vessels, along with postoperative systemic heparinization.