Clinical analysis of complete survival outcomes in digital replantation with a focus on avulsion injuries.

In this study, we defined complete digital survival as the primary outcome and systematically examined preoperative, intraoperative, and postoperative factors influencing this outcome. We enrolled 124 digits replanted and evaluated the correlation between complete survival and preoperative factors such as age, Tamai's zone classification, injury mechanism, smoking, daily cigarette consumption, diabetes, and complete/incomplete amputation. We considered avulsion to be a factor that could influence intraoperative and postoperative factors. Multiple logistic regression was performed with intraoperative and postoperative variables, such as the number of vessel anastomoses and rescue surgery. The characteristics of this study included 29 % avulsions, 39 % crushes, 29 % blunt cuts, and 6 % clean cuts. The total complete survival rate was 80 %. Multiple logistic regression adjusted for avulsion showed that the number of arteries, veins, and number of vein anastomoses ≥ number of artery anastomoses significantly contributed to complete survival in the whole study. However, the success of the replanted digits that needed rescue surgery was significantly poorer than that in the case without rescue surgery. In addition, the vessel transfer, such as vein grafting, was useful for replanting digits in cases with severe vessel damage. We should anastomose as many veins and arteries as possible and perform vessel transfer to replace the damaged vessel during the initial surgery. This effort in replantation may reduce reoperation rates and improve the chances of complete survival.