Survival rates and risk factors for failure using an interposition vein graft for fingertip amputations with segmental vessel defects

Abstract

PurposeThis study aimed to compare survival rates and risk factors of replantation failures using an interposition vein graft in fingertip amputations with segmental vessel defects with those using simple end‐to‐end anastomosis in amputations.Patients and methodsBetween 2004 and 2015, 776 (647 males and 129 females) with single Zone I or II amputations of digits underwent replantation. Among these, simple end‐to‐end anastomosis was performed in 698 replantations, while interposition vein grafts were used for either arterial or venous repair or both in 78 amputated fingertips. The survival rate was compared between the groups. Logistic regression analysis was performed to identify risk factors predicting replantation failure in all study subjects.ResultsAmong 776 replantations, 713 (91.9%) survived. At latest follow‐up, of 698 cases in the simple anastomosis group, 650 (93.1%) survived; of 78 cases in the vein graft group, 63 (80.8%) survived (p > .001). Logistic regression analysis revealed that avulsion type (odds ratio [OR] 3.121; 95% confidence interval [CI], 1.211–8.064; p = .018) and zone II amputation (OR, 2.370; 95% CI, 1.382–4.065; p = .002) were significant risk factors for replantation failure.ConclusionThis study demonstrates that the survival rate (80.8%) of the vein graft in fingertip amputation with segmental vessel defects was shown to be a possible option to increase the survival rates in case with segmental vessel defects where simple anastomosis could not be performed. However, avulsion type and zone II amputation are important risk factors of replantation failures.

Selection Bias in Avoiding Vein Graft in Replantation/Revascularization May Exist in Distal and Proximal Amputations, Respectively

“…Moreover, even if the intima is intact, damage to the soft tissue may affect the circulation in cases of avulsed or crushed amputation. [13][14][15][16] Lee et al reported that there was no difference in the success rate between the groups with and without vein grafts. 6 However, they also reported that vein graft should not be advocated, if the possibility of a meaningful functional recovery of the digit is low.…”

“…Vein grafting with two anastomoses doubles the possibility of technical failure and thrombogenic response to vessel trauma, possibly promoting flow disturbances and subsequent thrombus formation. [13][14][15][16] It is imperative that an adequate resection of injured vessels is performed, which may require an interpositional graft to bridge the gap. Recent studies have suggested that the success rate is similar between replantation/revascularization with and without vein graft.…”

Comparing Clinical and Aesthetic Outcomes of Digital Artery Flap using Nail Bed Graft for Fingertip Amputation with Replantation

“…In these cases, we used an interposition vein graft harvested from the distal volar forearm. 4 Veins and nerves were repaired if suture was possible; however, if it was difficult, nerve repair was not performed, and venous drainage was provided by an external bleeding method with a fish-mouth incision at the distal end of amputations for approximately 7 days. 5 The nail bed and distal fragment was harvested from the distal stump and grafted, and a palmar advancement flap was performed.…”

Vein Grafts in Free Flap Reconstruction: Review of Indications and Institutional Pearls

“…Although the success rate of interposition vein grafting for fingertip replantations is acceptable at 80.8 percent, it is lower than the survival rate of 93.1 percent in the simple end-to-end anastomosis group. 26 Another method of repairing vessel gaps during replantation is transposition vein grafting. In a single-institution study on thumb replantation, the authors report transposing the vein on the dorsal radial side of the index finger so that only one anastomosis is performed.…”