Eight cases of nine-digit and ten-digit replantations.

Amputations involving nine and all ten digits are very rare because of the different lengths of the digits, and it is also unusual to have all digits suitable for replantation. At Korea University Guro Hospital, from March 1987 to April 1992, three cases of 10-digit and five cases of 9-digit complete amputations were replanted by microsurgical technique. All eight cases involved young, healthy male patients, and the causes of amputation were either a cutter of press machine. The replantations were done under general anesthesia simultaneously on both hands by eight microsurgeons divided into a total of four teams. The operating times ranged from 19 to 31 hours, and the total amounts of transfused blood ranged from 6 to 38 pints. The warm ischemic times ranged from 10 minutes to 15 hours, and the cold ischemic times ranged from 3 to 29 hours. The sequence of replantation was radial digit to ulnar digit. In five of the eight patients, all of the replanted digits survived. Necrosis occurred in one and two digits in two patients with nine-digit replantations. Also, necrosis occurred in three digits in a patient who had had nine digits amputated by a press machine, sustaining severe crush injuries. The overall survival rate was 92 percent. In multidigit replantations involving 9 or 10 digits, there are a number of problems that must be overcome, including a long operating time, long ischemic times, and a large amount of blood loss. The long ischemic times were not critically related to survival rate. The total amount of blood transfused was reduced from 38 pints in one of the initial cases to 6 pints by intermittent use of the pneumatic tourniquet and venous anastomosis before arterial anastomosis. Static two-point discrimination ranged from 3 to 22 mm, and palm to pulp distance ranged from 0 to 7 cm, 1 to 5 years postoperatively. Grasping power ranged from 13 to 65 lb, and pinching power ranged from 5 to 26 lb, which was 42 and 50 percent of the average power of a Korean adult male, respectively. All eight patients returned to work and are satisfied with the result, functionally and aesthetically.