To support the basis of our technique in the published article, “Reconstruction of Circulation in the Fingertip Without Vein Repair in Zone I Replantation,” we herein provide studies closely related to the reconstructed vascular loop.
In zone I fingertip replantation (Tamai classification), it is difficult to find an available vein on an amputee. Chen et al
1
reported contralateral digital proper artery (DPA) anastomosis to the dorsal vein of the stump with a vein graft. All 4 digits survived. The same technique and similar results were also reported both clinically and experimentally.2
, 3
These studies concluded that vascular shunting provided channels for drainage1
and can effectively reduce the venous workload.A DPA gives off dorsal cutaneous branches at the distal interphalangeal joint.
4
, 5
, 6
Ozdemir et al7
and Cui et al8
performed flaps for coverage of fingertip defects. The flap was harvested from the dorsal side of the finger based on the DPA branches. Their studies showed that blood flow continued through the branches to arteriovenous communication.Indeed, ligating the larger DPA serves to reduce inflow into the fingertip. In addition, ligating and transecting vessels as described in our article can stop blood flow from the proximal part. Thus, blood flow can feasibly be transmitted through the anastomosis site into the proximal part. Moreover, the recurrent veins and the branches to periosteum, nail fold, and nail bed at the joint also serve as veins for drainage.
During the procedures, some large branches were ligated to avoid potential hemorrhage. In my experience, usually 2 to 5 ligations were performed in each case. The procedure is simpler than vessel grafting described by Chen et al,
1
in which vessel harvesting and additional vascular anastomosis were performed. Obviously, additional anastomosis is more likely to decrease revascularization and replantation success.Zone I fingertip replantation remains a challenge. Our technique provides an alternative method for fingertip replantation when vein-to-vein anastomosis is impossible.
References
- Distal digit replantation with an efferent AV anastomosis for absent venous drainage.J. Plast Reconstr Surg Assoc ROC. 1998; 9: 240-248
- Fingertip replantation with an efferent A-V anastomosis for venous drainage: clinical reports.Br J Plast Surg. 1993; 46: 187-191
- AV anastomosis as a solution for absent venous drainage in replantation surgery.Plast Reconstr Surg. 1983; 71: 525-528
- Reverse dorsal digital island flap.Plast Reconstr Surg. 1994; 93 (552–527)
- Vascular basis of dorsal digital and metacarpal skin flaps.J Hand Surg. 2001; 26A: 142-146
- An anatomical study of the dorsal cutaneous branches of the digital arteries.J Hand Surg. 2002; 27B: 577-579
- Innervated dorsal adipofascial turnover flap for fingertip amputations.Ann Plast Surg. 2001; 46: 9-14
- Innervated reverse island flap based on the dorsal cutaneous branch at distal interphalangeal joint of the digital artery.Chin J Microsurg. 2005; 1: 177-179
Article info
Identification
Copyright
© 2009 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.
ScienceDirect
Access this article on ScienceDirectLinked Article
- Reconstruction of Circulation in the Fingertip Without Vein Repair in Zone I Replantation: Reconstruction or Reduction?Journal of Hand SurgeryVol. 34Issue 3
- PreviewWe 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.
- Full-Text
- Preview
