This is a retrospective review of results for fingertip replantation over a 4-year period. Patients were evaluated for the presence or absence of venous anastamosis and whether or not this impacted fingertip survival. Fifty-nine patients with 67 fingertip amputations were studied. Zones as described by Tamai were further broken down into 4 subzones (described by Ishikawa). Subzones I-III were all distal to the terminal tendon insertion, and subzone IV extended from the DIP joint to the terminal tendon insertion. Most replantations were performed under digital blocks at this level. All digits had arterial anastamoses performed. However, some digits were unable to have venous anastamoses performed due to extent of injury or time limitations. The majority of amputations distal to the eponychial fold (Subzones I-II) hand no venous anastamosis. Subzone III (eponychial fold to terminal tendon insertion) had nearly equal numbers of no-venous anastamosis to fingertips with reconstructed venous outflow. Most subzone IV injuries had venous anastamoses performed.
An overall 85.6% survival rate was achieved. There was no difference in survival between digits with or without venous anastamosis in subzones I-III. However, none of the digits (n=2) in subzone IV replanted without venous anastamoses survived, versus 15 of 17 performed with venous anastamosis. The authors conclude that subzones I-III do not require venous anastamosis and that venous drainage in the immediate postoperative period can be augmented by loose skin approximation or a fish mouth incision at the finger tip to allow drainage until collaterals have developed. However, the authors conclude that zone IV replantations require venous anastamoses for survival.