Intermittent Bleeding Method after Replantation o the Distal Phalanx

Lee,  Byung Ho; Park,  Chan Il; Lee,  Jun Mo

doi:2011.20.1.38

Arch Hand Microsurg > Volume 20(1); 2011 > Article

Original Article

Journal of the Korean Society for Surgery of the Hand 2011;20(1):38-42.
Published online May 31, 2011.
DOI: https://doi.org/10.12790/jkssh.2011.20.1.38

Intermittent Bleeding Method after Replantation o the Distal Phalanx

Byung-Ho Lee, M.D.*, Chan-Il Park, M.D., Jun-Mo Lee, M.D.

¹Department of Orthopedic Surgery, Soo Hospital, Jeonju, Korea.
²Department of Orthopedic Surgery, Chonbuk National University Medical School and Research Institute of Clinical Medicine, Chonbuk National University, Jeonju, Korea. junmolee@jbnu.ac.kr

원위 수지 재접합술 뒤 간헐적 실혈 요법

, ,

¹
²

Abstract

Purpose: To evaluate the effect of intermittent bleeding method in the distal phalanx replantation.
Materials and Methods: From January 2007 through June 2009, authors have replanted 117 cases of distal phalangeal amputation in adults at Soo Hospital and Chonbuk National University Hospital. Cases of zone II were 60 cases and zone III 57 according to Allen classification. Male to female ratio was 8.7:1.3. The most common cause was machinery injury in the factory, 98 cases(83.8%), next one was belt injury of the machine, 11 cases(9.4%) and others, 8(6.8%). At least one digital artery and digital nerve were anastomosed under the operating microscope, but vein was impossible to anastomosis as unable to find out in the zone II and III. After anastomosis of one or more digital arteries and nerves, heparine(6,000-10,000 units) was kept to intravenous injection for 24 hours and at the same time fish mouth incision in 2-3 millimeter diameter was made in the distal radial and ulnar margin of the replanted distal phanlanx. From the first 30 minutes to an hour after replantation, incision site was swabbed with heparinized cotton ball for 5 minutes in every 30 to 40 minutes to make sure perfusion for 24 hours, every an hour at the second day, every two hours at the postoperative third to fifth day.
Results: 92 cases(78.6%) was completely survived at average postoperative third week follow-up and satisfied with preservation of the finger nail, digit length, good range of motion of the distal interphalangeal joint and acceptable sensibility at average 1.2 years follow-up.
Conclusions: Intermittant bleeding method in replantation of crushed distal phalanx impossible to anastomosis of vein at zone II and III of Allen classification was regarded as one of the notable salvage procedure.

Key Words: Intermittent bleeding method, Replantation, Crushed distal phalanx