指尖部切断再接着に対する静脈移植の適応と手術手技

抄録

In fingertip amputations, surgeons may encounter technical difficulties in vein grafting for anastomosis of small and fragile vessels.
In this retrospective study, we evaluated the survival rate, complications, and surgical techniques for fingertip replantation with vein grafting.
One hundred and twenty-five fingertip replantation procedures were performed in 116 patients between 1996 and 2017 at our hospital. There were 74 amputations in zone I and 51 in zone II. Twenty-five amputated fingertips in zone I were replanted with vein grafting for arterial or venous repairs. Among the 25 procedures with vein grafts, there were 11 with arterial repairs, 6 with venous repairs, and 8 with both arterial and venous repairs.
In the procedures with vein grafting, vascular thrombosis was found in 6, of which there were 4 arterial and 2 venous thromboses. In 4 cases of arterial thrombosis, the circulation gradually deteriorated within 2 or 3 days and subsequent necrosis of the replanted fingertip occurred, presumably because of severe damage to the soft tissue.
The overall survival rate of replantation with vein grafting was 84%.
Although skillful microsurgical techniques and longer operation times are in high demand, our results using vein grafts for successful fingertip replantation are encouraging.