Arterial-only anastomosis for fingertip avulsion amputations: survival rates and functional outcomes in a retrospective study of 194 digits

While not all fingertip avulsion amputations progress to necrosis after replantation, studies that examined survival rates of replanted digits or key influencing outcomes in fingertip avulsion amputations are lacking. Therefore, we investigated the incidence of postoperative vascular crises, survival rates of replanted digits, functional outcomes, and factors influencing outcomes in patients with fingertip avulsion amputations treated with arterial-only anastomosis. A retrospective study was conducted on completely amputated fingertips undergoing attempted replantation at Ningbo No. 6 Hospital between March 2017 and December 2024. Only digital arteries or arterial arch branches were identifiable for anastomosis; venous anastomosis was not feasible. According to our inclusion criteria, all 194 digits included in the final analysis had successful restoration of arterial blood flow confirmed intraoperatively. Group 1 included 84 patients with 98 avulsion amputations, and Group 2 included 82 patients with 96 clean-cut amputations. Postoperative vascular crises were recorded, and management—anticoagulation, thrombolysis, or intermittent bleeding—was tailored to arterial or venous compromise. Survival rates of replanted digits were assessed, and functional outcomes of surviving fingertips were compared between the groups. This study evaluated outcomes in a cohort of 194 digits. Arterial crises occurred in 28 digits (22 in Group 1; 6 in Group 2), whereas venous crises occurred in 86 digits (44 in Group 1; 42 in Group 2). In 22 digits (12 in Group 1; 10 in Group 2), venous crises preceded arterial crises. A total of 65 digits developed necrosis (42 in Group 1; 23 in Group 2). The overall survival rate was 66.5% (57.1% in Group 1; 76.0% in Group 2, p = 0.006). Functional scores for surviving digits were excellent in both groups. Despite a lower survival rate than conventional arterial–venous anastomosis, arterial-only replantation for fingertip avulsion amputations achieved a survival rate exceeding 50% in this study. The absence of tendon and joint injury at this level contributed to acceptable functional and cosmetic outcomes among surviving digits. Therefore, arterial-only replantation represents a feasible and valuable alternative for complex fingertip avulsions where venous repair is not possible, offering a worthwhile attempt at digital salvage in selected cases.