Hand Digit Revascularization: Could Be an “Elective-Urgence” Surgery?

TL;DR

This paper discusses a successful case of finger revascularization after a long ischemic period, challenging traditional time limits for such surgeries.

Contribution

The study presents a novel case demonstrating the feasibility of delayed finger replantation using microsurgical techniques.

Findings

A successful multi-digit revascularization was achieved after 72 hours of warm ischemia.

The patient showed good recovery of motor and sensory function post-surgery.

Current literature on ischemia time limits is found to have significant limitations.

Abstract

Background: A continuous obstacle that has limited access to and implementation of finger replantation surgery is timeliness, as ischemia time is traditionally considered a crucial factor for success. However, claims that the vitality of amputated fingers decreases after 6 h of warm ischemia and 12 h of cold ischemia are mostly based on theoretical considerations. Methods: Here we present a case of multi-digit revascularization after 72 h of warm ischemia using the microsurgical arteriovenous bypass technique. Results: In the reported case, revascularization was performed after a long ischemic period and showed good recovery of motor and sensory function. Conclusions: We identified significant limitations in the literature supporting time limits of ischemia and recent evidence demonstrating the feasibility of delayed finger replantation. The current treatment approach for amputation injuries often requires transfers or nighttime emergency procedures, increasing costs and limiting the national availability of finger replantation. Changes to finger replantation protocols based on evidence could expand access to this service and improve the quality of care.

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