Negative pressure wound therapy (NPWT) is widely used in skin defects, active infection, and surgical reconstruction; lately, it is being used after skin graft to improve the adhesion on the receptor area. During the last decade, another indication has been identified: the use of NPTW to avoid complications after free flaps such as venous congestion and the risk of necrosis. NPWT can be used in the initial complication of a free flap, and the venous congestions can be treated with this technique, with very good outcomes. NPWT can be established as a part of a postoperative protocol in microsurgical procedures to avoid major complications.

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Venous congestion is the most critical complication following microsurgical finger replantation and can present within the first postoperative days or even in the immediate postoperative period. 1 Several treatment options for this complication have been described, including leech therapy, 2 active bleeding of the fingertip or nail bed, 3 and systemic anticoagulation with a high risk of anemia and blood transfusion requirements. 4 Recently, negative pressure wound therapy (NPWT) has been identified as a novel method to treat venous congestion in free flaps. 5 These favorable results have allowed for exploration of the use of NPWT in venous congestion following finger replantation. We report three cases of finger replantation that developed venous congestion and were treated with NPWT as a salvage procedure. MATERIALS AND METHODSThis is a case series of three patients who underwent digit replantation. The postoperative course was complicated by venous congestion. NPWT was applied after the diagnosis of venous congestion since venous reconstruction was very challenging due to the amputation zone. All patients followed the same anticoagulation protocol previously described. 5 Settings and duration of NPWT of all three digits were recorded. RESULTSThe first patient is a 33-year-old woman with an amputation of the index finger at the level of the distal interphalangeal joint secondary to a table saw injury. Microsurgical anastomosis of one artery and one vein was performed 33 hours after her admission. Venous congestion and probable arterial insufficiency were identified 44 hours after the finger reimplantation and NPWT was initiated. Five days after continuous NPWT the finger was no longer congested and viable.The second patient is a 46-year-old man with an amputation of the left thumb at interphalangeal joint secondary to a table saw injury. Microsurgical anastomosis of one artery and one vein was performed after 8 hours of cold ischemia. Venous congestion was identified 96 hours later, and NPWT was applied. Three days after continuous NPWT, the thumb was less congested and was viable.The third patient is a 28-year-old man with an avulsion amputation of the right ring finger at mid-third of the proximal phalanx. Microsurgical anastomosis of one artery and two veins was performed after 2 hours of cold ischemia. Fracture of the head of the middle phalanx with avulsion of the flexor digitorium profundus and complete laceration of the extensor mechanism was the initial injury. The radial and ulnar nerves were sutured, and the

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