Survival after Digit Replantation and Revascularization Is Not Affected by the Use of Interpositional Grafts during Arterial Repair.

BACKGROUND: Interpositional grafts can be used to reconstruct the digital artery during revascularization and replantation when primary repair is not possible. The purpose of this study was to determine the effect of using interpositional grafts on the rate of digit survival. METHODS: A retrospective review of all patients from 2007 to 2016 that required revascularization and/or replantation of one or more digits was performed. RESULTS: One hundred twenty-seven patients were identified with 171 affected digits (118 digital revascularizations and 53 digital replantations). A graft was used to repair the digital artery in 50 percent of revascularizations (59 of 118) and in 49 percent of replantations (26 of 53). There was no difference in digit survival with use of an interpositional graft for arterial repair versus primary repair in revascularization (91.5 percent in both groups) or replantation (48.1 percent versus 46.2 percent; p = 0.88). Regression analysis demonstrated no association between the use of interpositional grafts and digit survival. Interpositional grafting was more likely to be used in crush (62.5 percent) and avulsion injuries (72.2 percent) compared with sharp laceration injuries (11.1 percent), with a relative risk of 5.6 (p = 0.01) and 6.5 (p = 0.006), respectively. CONCLUSIONS: There was no difference in the survival rate of amputated digits that required interpositional grafting for arterial repair. The need for an interpositional graft in a large zone of injury should not be considered a contraindication to performing revascularization or replantation. Furthermore, hand surgeons should have a low threshold for using interpositional grafts, especially in crush or avulsion injuries. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.

Duke Scholars

Author Christopher Scott Klifto Orthopaedic Surgery