Multiple venous anastomoses decrease the need for intensive postoperative management in Tamai zone I replantations
Retrospective cohort published in Arch Plast Surg (2017)
Abstract
BACKGROUND: Venous anastomosis is an important component of digital replantation, but is not always feasible, as some cases require external bleeding to treat venous congestion in the replanted tissue. In the present study, we evaluated the relationship between the number of vein anastomoses and the survival rate of Tamai zone I replantations. METHODS: A retrospective review was performed of all patients who underwent replantation of a fingertip amputation between 2014 and 2016. Patient charts were reviewed for demographic information, the mechanism of injury, the number of venous anastomoses, and the use of anticoagulation, external bleeding, and/or leeches. The cohort was divided into 3 groups depending on the number of venous anastomoses: no veins (group 1), a single vein (group 2), and 2 or more veins (group 3). Survival rates and external bleeding rates were analyzed across the groups. RESULTS: The review identified 143 fingertip replantations among 134 patients. The overall survival rate was 94% (135 of 143). Failures were due equally to venous complications (n=4, 50%) and to arterial complications (n=4, 50%). Our analysis did not identify any correlation between the number of veins anastomosed and the replant survival rate (P=0.689). However, a greater number of anastomoses was associated with a significantly lower frequency of external bleeding (P=0.017). CONCLUSIONS: The number of venous anastomoses was not correlated with the survival rate. However, a greater number of venous anastomoses was associated with a decreased need for external bleeding, corresponding to a significant decrease in the need for postoperative monitoring and leech therapy.
Abstract sourced from PubMed (NCBI) for the cited record. See the original publication for the authoritative version.
Resumen
143 fingertip replantations: greater number of vein anastomoses correlated with significantly lower frequency of external bleeding and reduced need for leech therapy, though overall survival did not differ by vein count.
Por qué esto importa para la hirudoterapia
Esta revisión retrospectiva de 143 reimplantes de punta de dedo (134 pacientes) evaluó si el número de anastomosis venosas (cero, una, o dos o más) afectaba las tasas de supervivencia y la necesidad de sangrado externo o terapia con sanguijuelas. Si bien las tasas de supervivencia no difirieron significativamente entre los grupos, un mayor número de anastomosis venosas se asoció con una necesidad significativamente menor de sangrado externo y, por tanto, de terapia con sanguijuelas. Para el ámbito de ASH, este estudio es relevante porque identifica factores quirúrgicos que pueden reducir o eliminar la necesidad de terapia con sanguijuelas en el reimplante de punta de dedo. La principal salvedad es que la terapia con sanguijuelas no fue el criterio de valoración principal, sino una consecuencia derivada de las decisiones de manejo de la congestión venosa, de modo que el estudio aporta evidencia indirecta sobre cuándo podría evitarse la terapia con sanguijuelas, pero no evalúa su eficacia.
Citación
Multiple venous anastomoses decrease the need for intensive postoperative management in Tamai zone I replantations.
Ryu DH et al. · Archives of plastic surgery, 2017
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Añadido a la biblioteca ASH: May 26, 2026 · Última actualización del sitio: 18 de junio de 2026