Microvascular anastomosis and its application on the replantation of amputated digits and hands.

Successful microvascular anastomosis depends upon the applications of magnifications, special instruments and fine suture materials, and the surgeon's skill in the technique. The key points of one millimeter vessel anastomosis are the wall-to-wall coaptation of the vessel ends, the fewer number of interrupted stitches with relatively loose knot. To gain good coaptation, an oblique insertion of a needle through the vessel wall must be used. In a thin-walled vein repair, the lumen should always be kept open with frequent irrigations. Between July 1965 and December 1976, 150 digits out of 168 in 111 cases and 11 hands in 11 patients were successfully replanted. All tissues must be repaired primarily. The repair of artery is performed first, recirculation is allowed with systemic heparinization, followed by vein anastomosis. The rehabilitation is commenced from the first day. To gain good function, several reconstructive surgeries may be necessary on the replanted digit or hand.