During replantation of digits amputated at the distal phalanx level, venous anastomosis is often impossible, and it is important to take measures to prevent congestion after surgery. Based on the retrospective examination of postoperative results, we previously demonstrated the usefulness of medical leeches. This report is a supplemental study including the surgeries performed after the previous study. Between May 2013 and April 2016, we performed 62 artery-only fingertip replants in 59 patients. Of 62 fingertips, 45 (73%) replanted fingertips survived. Medical leeches were used for continuous bleeding in 39 fingertips, 36 (92%) of which survived. Arterial insufficiency occurred in 2 patients, and another replantation failed due to an excessively short bloodletting period, for a total of 3 salvage failures. A fish-mouth incision was used for continuous bleeding in 7 fingertips, and 4 (57%) survived. There was no bloodletting in 16 fingertips, and 5 (31%) survived. Even if the vein cannot be reconstructed, taking proper anti-congestion measures will lead to reliable success, and using medical leeches is highly useful for this purpose.
