To the Editor:
We read the article by Zhang et al. on “Reconstruction of Circulation in the Fingertip Without Vein Repair in Zone I Replantation” with some interest. We can only commend their results on a 96% overall success rate and cannot on this basis critique their technique. However, the physiological explanation upon which their technique is predicated is fundamentally flawed and overcomplicated. The authors talk about reconstructing an internal circulation within zone I by repairing both digital arteries and then ligating the larger artery, located dorsally, at the L point and either ligating or transecting its medial and volar branches distal to the L point. Thus, they argue that this vessel is now transformed into a vein and able to complete an efficient vascular loop, remedying the perennial problem of venous congestion. Unfortunately, we believe this to be untrue, and ligating the larger of the two arteries serves to merely limit the inflow into the fingertip significantly, thereby effectively reducing the workload on the venous side of the circuit. This is based on the fact that the metabolic demands of the fingertip are more than adequately met by the two proper digital arteries and that survival is more than feasible on the supply of one. Although the explanation provided by Zhang et al. is a more attractive one, we strongly believe in “calling a spade a spade. We therefore look forward to the authors' comments.
© 2009 Published by Elsevier Inc.