Relationship Between Vein Repairs, Postoperative Transfusions, and Survival in Single Digit Replantations
Michael Milone, MD1; Christopher Klifto, MD1; Z-Hye Lee, MD1; Vishal D Thanik, MD1; Jacques Henri Hacquebord, MD2
1New York University Hospital, New YorkYork, NY; 2University of California Irvine, Orange, CA
INTRODUCTION: Replantation success depends on sufficient arterial inflow and venous outflow. We hypothesize that increased number of vein repairs leads to improved venous outflow, lower need for leeching, lower transfusion requirements, and higher rates of survival.
METHODS: We performed a retrospective review of single digit replants distal to the mid-metacarpal level in adult patients from 2007-2017 obtaining data on demographics, mechanism and level of injury, veins repaired, postoperative transfusions, and replant survival.
RESULTS: There were a total of 54 single digit replants (49 males), 13 of which were smokers. A single digital artery was repaired in all cases, 44% of which were anastomosed using an interposing vein graft. A mean of 1.5 veins were repaired per digit. The mean transfusion requirement was 1.7 units, and mean length of stay was 10.2 days. The survival rate was 50%.
There was a bimodal distribution between vein repairs and other outcome measures. Digits with 1 or 2 veins repaired required less (p=0.01) transfusions (means 1.1 and 1.3 transfusions) compared to digits replanted with 0 or 3 veins repaired (means 3.5 and 2.9 transfusions). Similarly, digits with 1 or 2 veins repaired had higher (p<0.01) survival rates (57% and 61%) than digits replanted with 0 or 3 veins repaired (25% and 29%). Likewise, digits replanted with 1 or 2 veins repaired trended towards lower (p=0.1) leeching requirements (means 5.3 and 7.6 days) than digits replanted with 0 or 3 veins repaired (means 9.7 and 13.5 days).
There were no differences in length of stay (9.5 vs 10 days, p=0.37), days leeched (5.3 vs 7.6 days, p=0.25), transfusion requirements (1.1 vs 1.3 units, p=0.75), nor survival (56% vs 61%, p=0.78) between digits replanted with 1 vein repair versus 2 vein repairs.
CONCLUSION: The data showed a higher leeching requirement, higher transfusion requirement, and poorer survival for digits replanted with 0 or 3 vein repairs compared to digits replanted with 1 or 2 vein repairs. This did not support our hypothesis that more vein repairs were protective against iatrogenic bleeding, transfusions, and replant failure. This supports the argument that 1 vein repair may allow for higher outflow through a single vein than if divided between 2 veins, which may in turn be more likely to thrombose. At the very least, this theoretical benefit of higher flow through a single vein repair appears to argue against the classic teaching that a second vein repair is necessary.
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