Successful microvascular replantation of a completely amputated finger after 25 hours of ischemia: A case report

Abstract

Microvascular surgery to replant amputated fingers remains a challenge for surgeons due to the small size of the blood vessels, requiring high technical proficiency and specialised equipment. Despite these challenges, it is the optimal method for restoring both the highest level of function and aesthetics to the hand. Consequently, it is estimated that tens of millions of such procedures are performed worldwide annually. However, the duration of finger ischemia (lack of blood supply) remains a major barrier to surgical indication. In global medical literature, the prevailing view - based largely on theoretical considerations - is that the viability of an amputated finger declines after 6 hours of warm ischemia or 12 hours of cold ischemia. This article presents a remarkable clinical case involving the successful replantation of a finger after 25 hours of ischemia, a feat previously unrecorded in Vietnamese medical literature. Case report: A 38-year-old male patient underwent microvascular replantation of the second digit (index finger) 25 hours after a complete amputation. At the two-month post-operative follow-up, the finger was fully viable with partial recovery of motor function and sensation, providing an excellent aesthetic result. This outcome demonstrates that adjusting surgical indications based on scientific evidence can significantly improve the quality of life for patients.