Standardized protocol for artery-only fingertip replantation
Buntic RF, Brooks D (2010) · The Journal of Hand Surgery · n=19
Perfil del estudio
- Diseño
- single-center, prospective cohort study with standardized protocol for artery-only fingertip replantation, evidence level IV therapeutic (Buncke Clinic, California Pacific Medical Center, San Francisco, USA)
- Tamaño de la muestra (n)
- 19
- Intervención
- Standardized postoperative protocol of intravenous dextran-40, heparin, aspirin, and medicinal leech therapy after artery-only fingertip replantation; bleeding promoted until physiologic venous outflow restored by neovascularization (mean 6 days)
- Comparador
- No randomized comparator - protocol evaluated against published artery-only replantation literature
- Punto final primario
- Replant survival; secondary outcomes length of hospital stay, transfusion requirements, fluorescent dye perfusion studies for circulatory competence
- Resultado primario
- All 19 of 19 replants survived (100%); average length of hospital stay 9 days (range 7-17); 11 of 19 patients required blood transfusions; average transfusion 1.8 units (range 0-9); all patients satisfied with the decision to replant and the cosmetic result
- Duración del seguimiento
- post-discharge follow-up until full functional outcome assessment
- PMID
- 20807626
Hallazgos clave
- 100% replant survival (19 of 19) in artery-only fingertip replantation using a standardized dextran-40 + heparin + aspirin + leech therapy protocol
- Most-cited US hand-surgery protocol for artery-only fingertip replant management
- Defines the role of medicinal leeches alongside systemic anticoagulation rather than as a sole salvage modality
- 58% of patients required transfusion (mean 1.8 units) - documents the predictable transfusion burden of multi-day leech bleeding protocols
- Hospital stay 9 days median - clinically meaningful resource utilization signal for the technique
Limitaciones
- Single US center with single surgical team - protocol fidelity may not replicate in other settings
- Small sample (n=19) - 100% survival rate could mask outliers in larger samples
- No control arm - cannot isolate the contribution of leech therapy from systemic anticoagulation
- Selected patient population (artery-only replants are a specific subset of all fingertip injuries)
- Transfusion rate (58%) is high - clinically meaningful for anemia-prone or transfusion-refusing patients
Implicaciones clínicas
Buntic 2010 established the most-cited US hand-surgery protocol for artery-only fingertip replantation and explicitly places medicinal leech therapy within a comprehensive postoperative anticoagulation strategy rather than as a standalone intervention. The 100% replant survival is striking but should be interpreted within the small sample (n=19) and surgeon-experience context. For US clinicians, this is the canonical reference describing how leech therapy is integrated into US-practice hand-surgery protocols. The transfusion burden (58% with mean 1.8 units) is a clinically meaningful counseling point for patients with anemia or religious transfusion refusal.
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