The Success of Finger Replantation: Key Factors and Surgical Techniques
The success of finger replantation largely depends on the ability to restore the vascular connection. In 1965, Kleinert pioneered the use of magnification to reconnect finger vessels, while Buncke's microsurgical techniques led to successful replantation experiments on rabbit ears and monkey thumbs. Following these groundbreaking studies, reports from Chinese medical professionals and Japanese scholar Komatsu in 1968 showcased successful complete thumb replantations. Today, advanced microsurgical techniques have facilitated complex procedures such as finger replantation for children and multiple digit reconnections, marking a significant advancement in the field.
What Are the Treatment Methods for Finger Amputation?
The treatment for finger amputation includes specific surgical indications beyond just the replantation of severed limbs. The following guidelines are critical:
Indications for Surgery
1. In cases of thumb amputation, *efforts should be made to attempt replantation*.
2. For the remaining four fingers, replantation should be pursued sequentially based on severity and indication.
3. In cases of multiple digit amputation, if the middle finger is severely damaged but the ring and little fingers are intact, replantation of the index and middle fingers may be considered.
Important Surgical Considerations
1. During the procedure, it is crucial to follow the order of reattaching bones, extensor tendons, dorsal veins, arterial vessels, nerves, tendons, and skin.
2. If a finger is completely severed at the proximal interphalangeal joint, reattachment must ensure alignment with the blood vessels (both arteries and veins), regardless of how clean the cut is. Otherwise, the digit may not survive.
3. Given the small diameter and thin walls of finger blood vessels, the surgical process must be performed with precision, gentleness, patience, and meticulous attention to detail. It is advisable to utilize a surgical microscope for vessel anastomosis to enhance the success rate of finger replantation.
Postoperative Care
Following surgery, effective postoperative management is essential for the vitality of the replanted finger:
- Commonly used medications include vasodilators to manage vascular spasms.
- Maintain room temperature between 20-25°C, utilizing local heating methods (like a 60W lamp approximately 50 cm away) or air conditioning to control the ambient temperature.
- Except for using Dextran 40, heparin is generally not required.
With advancements in microsurgery, the ability to successfully reattach fingers has dramatically improved. Awareness of surgical techniques, indications, and postoperative care plays a vital role in enhancing patient outcomes.