Delayed-onset functional ischemia 16 years after digital replantation: A Raynaud's-like vasospasm case report
Research article published in JPRAS open (2026)
Abstract
Reports of long-term complications following finger replantation are scarce. Vascular crises occurring more than a decade after surgery are particularly rare. We present the case of a 27-year-old male who developed with acute cyanosis and reduced skin temperature of the left index finger, occurring 16 years after digital replantation. The patient had undergone replantation of the left index and middle fingers in childhood. He reported chronic smoking and frequent cold-water exposure prior to symptom onset. Imaging demonstrated narrowing of the proper palmar digital artery of the index finger, with diminished distal perfusion and no evidence of mechanical obstruction. Ambulatory blood pressure monitoring revealed uncontrolled hypertension (141/101 mmHg). Based on his risk factors and imaging findings, a diagnosis of vasospastic ischemia, consistent with a Raynaud's-like phenomenon likely triggered by tobacco use and cold exposure, was made. The patient responded well to infrared thermotherapy and vasoactive agents (nifedipine, bisoprolol, and beraprost sodium), with complete resolution of symptoms. This case highlights that replanted digits, due to incomplete reconstruction of the microvascular network, may remain vulnerable to vasospastic insults even many years later. It underscores the importance of lifelong risk mitigation, particularly the avoidance of reversible triggers such as smoking and cold exposure.
Abstract sourced from PubMed (NCBI) for the cited record. See the original publication for the authoritative version.
Resumen
Peer-reviewed clinical and outcomes research relevant to medicinal leech therapy and its biology. Indexed in PubMed and verified against the NCBI record.
Por qué esto importa para la hirudoterapia
Este informe de caso (Wu et al., 2026) describe a un hombre de 27 años que desarrolló cianosis aguda y reducción de la temperatura cutánea en el dedo índice izquierdo 16 años después de una replantación digital en la infancia, con imagenología que mostraba estrechamiento de la arteria digital palmar propia y sin obstrucción mecánica; se diagnosticó y resolvió una isquemia vasoespástica, similar a la de Raynaud, vinculada al tabaquismo, la exposición al frío y la hipertensión no controlada, mediante termoterapia infrarroja y agentes vasoactivos. Es relevante para la hirudoterapia como un recordatorio de que los dedos replantados, candidatos comunes para la terapia con sanguijuelas temprana en el postoperatorio para aliviar la congestión venosa, retienen una red microvascular incompletamente reconstruida que permanece vulnerable a crisis de perfusión mucho después de la cirugía. Aviso: este es un caso de presentación tardía único tratado con termoterapia y fármacos en lugar de sanguijuelas, por lo que ofrece una observación clínica preventiva, no evidencia sobre la eficacia de la terapia con sanguijuelas.
Citación
Delayed-onset functional ischemia 16 years after digital replantation: A Raynaud's-like vasospasm case report.
Wu et al. · JPRAS open, 2026
Contexto clínico relacionado
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Añadido a la biblioteca ASH: May 28, 2026 · Última actualización del sitio: June 18, 2026