Digital replantation failure with underlying essential thrombocytosis

Thrombosis is one of the complications following replantation or microvascular surgery, causing 80% of replantation failure. Thrombophilia is recognized as an additional risk factor for vascular thrombosis and it is associated with an incidence rate of 20% of microvascular surgery failure. We report here a case of a 56-year-old workman who caught his non dominant left hand in a circular saw, amputating his third and fourth finger. The patient was affected by essential thrombocytemia, a chronic myeloproliferative disorder in which sustained megakaryocyte proliferation leads to an increase in the number of circulating platelets, and a clinical course complicated by thrombotic episodes. Due to the extensive damage, a single-finger replantation was attempted after full disclosure of the high risk of complications, with antithrombotic therapy started intraoperatively. Our case shows the delayed negative outcome of a microvascular procedure in spite of a proper surgical technique, due to pathological thrombophilia.