Digital Artery Massage for Improving Ischemia after Distal Digital Replantation Surgery
07 January 2018
05 March 2018
24 April 2018 (online)
Distal digital replantation is frequently associated with arterial thrombosis and/or spasm, leading ischemia in the replanted tissue. This report introduced a rescue technique for ischemia after distal digital replantation without reanastomosis. Two males, 64 and 51 years old, underwent Ishikawa subzone II finger amputations. Microsurgical replantations with vein grafts were performed. Intraoperatively, heparin and urokinase through intra-arterial infusion were given for one week. At 40 to 48 hours after surgeries, the replanted digits developed ischemia; massaging digital arteries at the proximal phalanx regions with running warm water was immediately initiated and ischemia was improved. In both cases, the replanted tissues were rescued, though a partial necrosis requiring full-thickness skin grafting was found in one case. This massage was easily, safely, and effectively performed without complications and was applicable in cases with ischemia after distal digital replantation, especially where reanastomosis was unfeasible.
This study was performed in accordance with the World Medical Association Declaration of Helsinki (June 1964) and subsequent amendments. The patients voluntarily gave written informed consent to participate in this study.
* Yosuke Niimi and Hiroshi Ito contributed equally to this report.
- 1 Moiemen NS, Elliot D. Composite graft replacement of digital tips. 2. A study in children. J Hand Surg [Br] 1997; 22 (03) 346-352
- 2 Ishikawa K, Ogawa Y, Soeda H, Yoshida Y. A new classification of the amputation level for the distal part of the fingers. J Jpn Soc Microsurg 1990; 3: 54-62
- 3 Ito H, Sasaki K, Morioka K, Nozaki M. Fingertip amputation salvage on arterial anastomosis alone: an investigation of its limitations. Ann Plast Surg 2010; 65 (03) 302-305
- 4 Jazayeri L, Klausner JQ, Chang J. Distal digital replantation. Plast Reconstr Surg 2013; 132 (05) 1207-1217
- 5 Brent B. Replantation of amputated distal phalangeal parts of fingers without vascular anastomoses, using subcutaneous pockets. Plast Reconstr Surg 1979; 63 (01) 1-8
- 6 Kim KS, Eo SR, Kim DY, Lee SY, Cho BH. A new strategy of fingertip reattachment: sequential use of microsurgical technique and pocketing of composite graft. Plast Reconstr Surg 2001; 107 (01) 73-79
- 7 Askari M, Fisher C, Weniger FG, Bidic S, Lee WP. Anticoagulation therapy in microsurgery: a review. J Hand Surg Am 2006; 31 (05) 836-846
- 8 Maeda M, Fukui A, Tamai S, Mizumoto S, Inada Y. Continuous local intra-arterial infusion of antithrombotic agents for replantation (comparison with intravenous infusion). Br J Plast Surg 1991; 44 (07) 520-525
- 9 Atiyeh BS, Hashim HA, Hamdan AM, Moucharafieh RS. Local recombinant tissue plasminogen activator (rt-PA) thrombolytic therapy in microvascular surgery. Microsurgery 1999; 19 (06) 265-271
- 10 Lin CH, Aydyn N, Lin YT, Hsu CT, Lin CH, Yeh JT. Hand and finger replantation after protracted ischemia (more than 24 hours). Ann Plast Surg 2010; 64 (03) 286-290