title: Nonarterialized venous replantation of part of amputated thumb-a case report and review of the literature.
abstract: Since the first successful replantation of a human thumb reported by Komatsu and Tamai in 1968, thousands of severed digits and body parts have been successfully salvaged. Restoration of anatomic form and function are the goals of replantation after traumatic tissue amputation. Regardless of anatomic location, methods include microsurgical replantation and nonmicrosurgical replantation, such as composite graft techniques. Numerous techniques to maximize tissue survival after revascularization have been described, including "pocket procedures" to salvage composite grafts, interposition vein grafts, and medicinal leeches to name a few. Artery-to-venous anastomoses have been performed with successful "arterialization" of the distal venous system in fingertip replantation. Although there is documented survival of free venous cutaneous flaps, to our knowledge this is the first report of a replanted composite body part (bone, tendon, soft tissues, and skin) utilizing exclusively multiple, microvascular, nonarterialized venous-venous anastomoses. We present a patient with an isolated band saw fillet amputation to the back of the thumb at the metacarpal-phalangeal joint region, resulting in a composite graft composed of bone, tendon, soft tissue, and skin. The hand wound provided no viable regional arterial inflow source, but there were multiple good caliber superficial veins present. The amputated tissues were replanted and revascularized by using only venous blood flow. The replanted part survival was 100% with excellent function of the digit. We conclude that a hand composite body part involving bone, tendon, soft tissues, and skin can survive replantation with a strict venous blood supply if sufficient good caliber, microvascular, venous-venous anastomoses are performed, granted that arterial inflow options are not available. This is an isolated case, yet introduces a new way of thinking regarding tissue replantation.
authors.affiliation: Division of Plastic, Reconstructive, and Cosmetic Surgery (MC958), University of Illinois at Chicago College of Medicine, Suite 515 CSN, 820 South Wood Street, Chicago, IL, 60612-7316, USA.
authors.forename: Ramasamy
authors.initials: R
authors.lastname: Kalimuthu
authors.forename: Glenn E
authors.initials: GE
authors.lastname: Herrmann
references.citation: J Hand Surg Am. 2001 Nov;26(6):1120-4
references.pmid: 11721262
references.citation: Acta Chir Plast. 1995;37(3):67-70
references.pmid: 8991208
references.citation: Plast Reconstr Surg. 1979 Jan;63(1):1-8
references.pmid: 432310
references.citation: Plast Reconstr Surg. 1977 Aug;60(2):233-41
references.pmid: 329303
references.citation: Microsurgery. 1998;18(5):324-30
references.pmid: 9819180
references.citation: Plast Reconstr Surg. 1999 Apr;103(5):1428-35
references.pmid: 10190439
references.citation: Br J Plast Surg. 1978 Oct;31(4):300-8
references.pmid: 361131
references.citation: J Hand Surg Am. 1990 Jan;15(1):160-5
references.pmid: 2299158
references.citation: Plast Reconstr Surg. 2004 Jan;113(1):247-53
references.pmid: 14707643
references.citation: Br J Plast Surg. 1991 Apr;44(3):230-3
references.pmid: 2025762
references.citation: Ann Plast Surg. 2002 Feb;48(2):189-92
references.pmid: 11910226
references.citation: Plast Reconstr Surg. 1996 Feb;97(2):408-12
references.pmid: 8559824
references.citation: J Reconstr Microsurg. 1993 Jan;9(1):1-4
references.pmid: 8423556