Risk factors for failure of replantation of severed distal finger / 中华创伤杂志

ABSTRACT

Objective To investigate the most important risk factors leading to failure of replantation of severed distal fingers so as to provide theoretic foundation for an improvement of survival rate. Methods Medical records of 65 amputated distal fingers underwent replantation were retrospectively studied to determine the independent risk factor for failure by using univariate and multivariate statistical analyses. Results Of 65 fingers treated with replantation, 8 (12%) failed. Univariate analysis showed that the increase of platelet level was the risk factor leading to failure of replantation (P= 0.041) . Manner of venous drainage (? 2=12.483, P=0.002), injury cause (? 2= 7.992, P= 0.018) , reconstruction of arteries (? 2=4.158, P=0.041) and preservation of the severed finger (? 2=6.240, P=0.044) were significantly correlated with the failure of replantation. However, multivariate logistic regression analyses showed that platelet level (OR=1.020, P=0.046) and manner of venous drainage (OR=0.154, P=0.040) were the significant independent predictors for failure of replantation. Six (38%) out of 16 amputated fingers replantation by means of single venous anastomosis resulted in failure. Of 26 amputated fingers treated with single venous drainage by bloodletting of finger tip, one (4%) failed. However, only one finger (4%) failed when 23 amputated fingers were treated with venous reflux by a combination of these two ways. Conclusions High level of platelet and venous reflux through anastomosis are the independent predictors affecting replantation of the severed fingers. Augmentation of anticoagulation as well as venous drainage determined by concrete lesion condition contribute to a higher clinical survival rate of replantation.