A comparative study of digital nerve and digital arterial repairs performed using running versus interrupted suture techniques in finger replantations

BACKGROUND: The present study aimed to retrospectively analyze replantations and compared the success rates of different suturing techniques.
METHODS: The data of 54 patients who underwent 82 finger replantations between January 2016 and April 2020 were retrospectively analyzed. Patients who underwent traumatic total finger amputations were included in the study. Arteries were repaired with two techniques, the simple running suture technique and the simple interrupted suture technique. Demographic patient data, comorbidities, operative data, post-operative care, the length of hospital stay, mechanism of injury, and site of injury were recorded. The groups were statistically analyzed. Functional outcomes were evaluated according to the Quick DASH score.
RESULTS: A total 54 patients with a mean age of 32.5±18.4 (range 1–75) who underwent finger replantation were included in the study. The mean duration of follow-up was 30.9±16.1 months. The mechanism of injury was guillotine-style injury in 29 (35.4%) fingers, avulsion injury in 15 (18.3%) fingers, and crush injury in 38 (46.3%) fingers. Forty-six fingers were repaired using a simple running suture technique, and 36 fingers were repaired using a simple interrupted suture technique. There was no statistically significant difference in terms of failure between the suture techniques (p=0.569). Further, although there was no statistically significant difference in Quick DASH scores according to the type of trauma in the simple running suture technique group (p=0.109), a comparison could not be made within simple interrupted suture technique group because of the small sample size. There was no statistically significant difference in failure rates between cases with an ischemia duration of <6 h and those with ischemia duration of 6–12 h (p>0.05). No statistically significant difference was found between the groups according to age, body mass index, arterial hypertension, or diabetes mellitus (p>0.05). Statistically significant differences were found in univariate analysis according to surgery time per digit, smokers, or vein repair (p<0.05). In total, 65 (79.3%) out of 82 finger replantations were successful. A total of 17 out of 30 fingers that could not undergo venous repair survived because of treatment with medicinal leeches.
CONCLUSION: Finger replantation is a difficult-to-perform surgical procedure requiring consideration of the surgical indications and the presence of an experienced surgical team. Regardless of the suture technique in finger amputations, performing venous anastomosis after arterial anastomosis is essential to restore circulation.

Parmak replantasyonlarýnda devamlý ve kesintili dikiþ teknikleri kullanýlarak gerçekleþtirilen dijital sinir ve dijital arter onarýmlarýnýn karþýlaþtýrmasý

AMAÇ: Bu çalýþma, replantasyonlarý geriye dönük olarak analiz etmeyi ve farklý dikiþ tekniklerinin baþarý oranlarýný karþýlaþtýrmayý amaçladý. GEREÇ VE YÖNTEM: Ocak 2016 ile Nisan 2020 arasýnda 82 parmak replantasyonu yapýlan 54 hastanýn verileri geriye dönük olarak incelendi. Travmatik total parmak amputasyonu yapýlan hastalar çalýþmaya dahil edildi. Arterler basit akan dikiþ tekniði ve basit aralýklý dikiþ tekniði olmak üzere iki teknikle onarýldý. Demografik hasta verileri, komorbiditeler, ameliyat verileri, ameliyat sonrasý bakým, hastanede kalýþ süresi, yaralanma mekanizmasý ve yaralanma yeri kaydedildi. Gruplar istatistiksel olarak analiz edildi. Fonksiyonel sonuçlar Quick DASH skoruna göre deðerlendirildi.
BULGULAR: Çalýþmaya parmak replantasyonu uygulanan, yaþ ortalamasý 32.5±18.4 (daðýlým 1–75) olan toplam 54 hasta alýndý. Ortalama takip süresi 30.9±16.1 aydý. Yaralanma mekanizmasý 29 (%35.4) parmakta giyotin tarzý yaralanma, 15 parmakta (%18.3) avülsiyon yaralanmasý ve 38 (%46.3) parmakta ezilme yaralanmasýydý. Kýrk altý parmak basit akan dikiþ tekniði ile, 36 parmak ise basit aralýklý dikiþ tekniði ile onarýldý. Dikiþ teknikleri arasýnda baþarýsýzlýk açýsýndan istatistiksel olarak anlamlý bir fark yoktu (p=0.569). Ayrýca basit akan dikiþ tekniði grubunda travma tipine göre Quick DASH skorlarýnda istatistiksel olarak anlamlý bir fark olmamasýna raðmen (p=0.109), örneklem büyüklüðünün küçük olmasý nedeniyle basit kesintili dikiþ tekniði grubu içinde karþýlaþtýrma yapýlamadý. Ýskemi süresi <6 saat olan olgular ile iskemi süresi 6–12 saat olan olgular arasýnda baþarýsýzlýk oranlarýnda istatistiksel olarak anlamlý fark yoktu (p>0.05). Gruplar arasýnda yaþ, VKÝ, arteriyel hipertansiyon veya diabetes mellitus (DM) açýsýndan istatistiksel olarak anlamlý fark bulunmadý (p>0.05). Basamak baþýna ameliyat süresine, sigara içenlere veya damar onarýmýna göre tek deðiþkenli analizde istatistiksel olarak anlamlý farklýlýklar bulundu (p<0.05). Toplamda 82 parmak replantasyonundan 65’i (%79.3) baþarýlý oldu. Venöz onarýmý yapýlamayan 30 parmaktan toplam 17’si týbbi sülük tedavisi nedeniyle hayatta kaldý.
TARTIÞMA: Parmak replantasyonu, cerrahi endikasyonlarýn dikkate alýnmasý ve deneyimli bir cerrahi ekibin varlýðýnýn gerekli olduðu, uygulanmasý zor bir cerrahi iþlemdir. Parmak amputasyonlarýnda dikiþ tekniði ne olursa olsun, arter anastomozundan sonra venöz anastomoz yapýlmasý dolaþýmýn yeniden saðlanmasý için esastýr.