Purpose: This retrospective case series examined wound complications after Tamai zone V replantation, and describes a potential strategy to increase the finger survival rate and improve function.
Methods: Nine patients (22 fingers) underwent Tamai zone V replantation at our institution between 2011/9 and 2017/5. We performed a detailed chart review to identify features of their postoperative soft tissue progress, finger loss rate and details of additional surgeries.
Results: Four patients (10 fingers) lost all replanted fingers, whereas in five patients (12 fingers) , all fingers survived. In all four failure cases, tissue necrosis developed gradually in the replantation zone covering the vascular anastomoses, and vascular thrombosis and spasm were observed approximately 1 week after the first replantation. In contrast, 3 out of 5 patients did not develop tissue necrosis. The fingers of the remaining 2 patients were salvaged by performing timely flap coverage of the necrotic tissue overlaying the vascular anastomoses.
Conclusion: Early flap coverage to the Tamai zone V replantation area may be effective in preventing vascular thrombosis and spasm leading to finger loss, and it made it easier to perform additional reconstructive surgeries.
