Successful Digital Replantation in a Hemodialysis Patient with an Ipsilateral Arteriovenous Fistula: A Case Report

Digital replantation in long-term hemodialysis patients presents significant challenges as chronic kidney disease is inherently associated with vascular calcification, endothelial dysfunction, and microvascular impairment. Arteriovenous fistulas (AVFs) used for hemodialysis also alter upper-extremity hemodynamics and may reduce distal perfusion. We report successful finger replantation in a 53-year-old man with end-stage renal disease who had undergone hemodialysis for 10 years through an ipsilateral radiocephalic AVF. The patient’s left middle finger was completely amputated at the distal phalanx level following a power-saw injury. Microsurgical replantation was performed with anastomoses of two digital arteries, three veins, and both digital nerves. Regular hemodialysis was continued postoperatively through the preexisting ipsilateral AVF. The replanted digit maintained stable circulation without pedicle thrombosis, access-related ischemic complications, or the need for vascular revision. At postoperative day 35, the digit displayed satisfactory wound healing. Approximately 1 year after replantation, the digit remained healthy with a two-point discrimination of approximately 5 mm, indicating substantial sensory recovery. This case suggests that the presence of a functioning ipsilateral hemodialysis AVF does not necessarily preclude successful distal digital replantation. Careful assessment of distal perfusion and recipient vessel quality, meticulous microsurgical reconstruction, and individualized perioperative management may allow successful replantation in appropriately selected patients.