Should the artery be trimmed before anastomosis in every finger replantation/revascularization case? Prospective, single-center, multidisciplinary study over 46 months - 05/07/23

Doi : 10.1016/j.otsr.2023.103646

Marine Pichonnat ^a,^b,^c,^⁎ , Alexandre Buffet ^a,^b,^c, Franck Monnien ^d, Sébastien Aubry ^e, Isabelle Pluvy ^a,^b,^c, François Loisel ^a,^b,^c, Laurent Obert ^a,^b,^c, Séverine Valmary-Degano ^f, Ines Regas-Guerzider ^g
^a Service d’orthopédie, de traumatologie, de chirurgie plastique, reconstructrice et assistance main, CHU de Besançon, 3, boulevard Alexandre Fleming, 25030 Besançon, France
^b Sciences médicales et pharmaceutiques, université de Bourgogne Franche-Comté, 19, rue Ambroise Paré, 25030 Besançon, France
^c Nanomédecine, imagerie, thérapeutique-EA 4662, université de Bourgogne Franche-Comté, Sciences Médicales et Pharmaceutiques, 19, rue Ambroise Paré, 25030 Besançon, France
^d Service d’anatomo-pathologie, CHU de Besançon, 3, boulevard Alexandre Fleming, 25030 Besançon, France
^e Service d’imagerie ostéoarticulaire, radiologie interventionnelle, CHU de Besançon, 3, boulevard Alexandre Fleming, 25030 Besançon, France
^f Service d’anatomo-pathologie, CHU de Grenoble, boulevard de la Chantourne, 38000 Grenoble, France
^g Chirurgie Orthopédique et Traumatologique Centre Hospitalier Public Edmond Garcin Hopitaux de Provence, 179 avenue des soeurs Gastine, 13677, Aubagne Cedex, France

^⁎Corresponding author.

Sous presse. Épreuves corrigées par l'auteur. Disponible en ligne depuis le Wednesday 05 July 2023

Abstract

Introduction

Despite optimal arterial anastomosis, some finger replantations fail. Our objective was to evaluate how the mechanism of injury (MOI) affects the artery's microscopic appearance and the success of anastomosis. We hypothesized that the MOI influences arterial histology and microsurgical success.

Methods

This single-center prospective study enrolled patients who had an acute traumatic arterial injury of the hand and/or wrist. The proximal and distal ends of the artery were trimmed before anastomosis in every case. The arterial margins were analyzed in anatomical pathology. Clinical follow-up along with an ultrasound arterial patency check was carried out at 1 month postoperative.

Results

Between 2018 and 2022, 104 patients were enrolled with a follow-up of 12 months. Macroscopically, 42% of the arterial margins were dilapidated. Histological analysis found damage in 74% of surgical specimens: blast (100%)>laceration by mechanical or power tool (92%; 82%)>amputation by mechanical or power tool (80%; 67%)>laceration by glass (50%)>crush injury (33%). The arterial margins were more likely to be normal based on the histological analysis when the MOI was laceration by glass (p<.05; OR=3.72) and the patient was 65 years or older (p<.01). Risk factors for anastomosis failure were an amputation by power tool (p<.01, OR 8.19) and shorter length of arterial resection (p<.02). The clinical failure rate was 7.8% and the patency failure rate was 10.4%.

Discussion

Histological arterial lesions correlate with the MOI. Trimming >2mm from the proximal and distal arterial ends is recommended for all MOI before arterial end-to-end anastomosis. For blast injuries or amputation, we recommend trimming>4mm and using a vein bypass graft. This study's findings could lead to a change in surgical practices.