The Clinical Study and Classification of Distal Fingers Replantation of 2230 Cases

Introduction: Replantation is an ideal technique for reconstruction following fingertip amputation as it provides ‘like for like‘ total reconstruction of the nail complex, bone pulp tissue and skin with no donor-site morbidity. This study is a clinical research on distal finger replantation and its classification, the purpose is to improve the survival rate of replantation.

Methodology and Material: Thirty-six damaged fingers with intact distal parts dissections were studied, focusing attention on the classification of the distal finger replantation. We summarized that the distal finger replantation can be classified to three types, based on the level it amputated. TypeⅠ, level between the crease of DIPJ and the nail root. TypeⅡ, level between the nail root and the fingerprint center. Type Ⅲ, level distal to the fingerprint center. From Jan 1995 to Mar 2013, 2230 cases(2645 fingers) of distal finger replantations were performed in our hospital, including 1434 fingers of typeⅠ, 737 fingers of type Ⅱ, 374 fingers of type Ⅲ. The artery diameter of typeⅠ and Ⅱ refers to 0. 3 mm ∼ 0. 6 mm, the dorsal and volar vein diameter refers to 0. 3 mm ∼ 0. 8 mm. The artery of type Ⅲ is showing dendritic, the diameter refers to 0. 1 mm ∼ 0. 3 mm, vein diameter refers to 0. 15 mm ∼ 0. 3 mm.

Results: The replantation survival rate of the three type was 97.7%, 95% and 97% respectively. Follow-up period was 9-24 months. And all the survived replanted fingers achieved good sensory recovery satisfied appearance.

Conclusions: The replantation of distal finger needs skilled microsurgical techniques. The Classification is important to choose the way of replantation. The vascular anastomosis required to be performed under the surgical microscope at 10x in typeⅠandⅡ, and 16x in type Ⅲ.