LAUSR

Successful replantation of fingertip amputations restores the original tissue and is the ideal treatment to provide the best aesthetic and functional outcome. However, successful fingertip replantation is considered challenging because it requires supermicrosurgery techniques. This article provides a detailed surgical technique for fingertip replantation and our preferences and recommendations. In our experience, the most important factors for successful fingertip replantation are meticulous vascular dissection, reliable arterial repair and venous anastomosis to avoid postoperative venous congestion. Proximal arterial dissection until pulsatile bleeding is encountered avoids the zone of vascular injury, and is particularly important in crush or avulsion amputations. Distal arterial dissection is performed until undamaged intima is identified. We believe anastomosis to the central artery is reliable even in Tamai zoneⅡ amputation. When an arterial defect is present, we recommend using a vein graft to anastomose to the central artery. In additional, we highly recommend at least one venous anastomosis to avoid postoperative venous congestion. In Tamai zoneⅠ, available veins can be found on the palmar side of the pulp. It is important to search directly below the dermis and remove adipose tissue around the vessels to secure space for anastomosis. We consider nerve suture in Tamai zoneⅠ and Ⅱ replantations inessential, because spontaneous sensory recovery can be expected. Postoperative management of venous congestion, spasm in artery, and arterial thrombosis are as important as surgery.