Background: Ever since the first reported case of a successful digit replantation, new instrumentation and surgical techniques have been developed that have significantly improved survival as well as functional outcome of these replantations. Reported success rates in the recent literature quote a 60 to 80 percent survival rate. Many methods are employed to achieve good resutls. The purpose of this study is to evaluate the methods used by a single surgeon including the use of vein grafts in the majority of the cases to achieve a success rate of over 95% survival.

Materials and Methods: between April 1994 and April 1998, 64 consecutive digits were replanted in 53 patients by a single surgeon. A retrospective chart review was performed on all patients. Survival, complications and functional outcomes were evaluated.

Results: The mechanism of injury was crush in 47 patients, clean-cut amputation in 12 and avulsion in 5. The level of amputation was zone 1 in 38 patients and zone 2 in 26 patients. Total vein grafts were used in 68 vessels. 30 vein grafts were for arterial anastomoses and 38 for venous anastomoses. In no patients was the bone shortened to decrease the distance between the vessel ends. Two patients had shortening of the phalangeal bone due to the severity of the crush injury. There were 2 complete failures out of 64 digits. 2 digits underwent re-exploration with salvage of one and another digit failed and was not re-explored. A success rate of 96.9% was achieved.

Discussion: As in any surgical procedure constant attempts are made to improve outcome. In this study multiple methods including the use of 11.0 suture, limited use of bone shortening, the use of anticoagulant therapy, and meticulous surgical technique have had a significant influence on achieving a low failure rate. However, the use of vein grafts and the choice of the appropriate vessels to use as vein graft has a significant role in improving the survival rate as well as the functional outcome in digit replantation. Here the use of vein grafts as a tool to improve results and achieve a survival of over 95% is emphasized and indication and methods of use are outlined.