title: Reconstruction of circulation in the fingertip without vein repair in zone I replantation.
abstract: OBJECTIVE
  In fingertip replantation, adequate venous drainage is important for success. As the level of amputation becomes more distal, anastomosis of veins becomes more technically difficult. External bleeding is a common solution to venous congestion, but the process is burdensome because of duration of bleeding for 3 or more days after surgery. We present a new technique for reconstructing circulation without vein anastomosis in zone I replantation and analyze the outcomes of this technique in terms of eliminating external bleeding and of a high survival rate of the replanted digits.
  
  
  METHODS
  Between 1997 and 2007, we performed 120 replantations in 112 patients (83 male and 29 female; mean age, 33 years; range, 3-54 years). All were zone I amputations, based on the Tamai classification. We surgically repaired both proper digital arteries, excluded the vein, and then ligated 1 of the arteries. Using this technique, circulation was restored. Included in the outcome evaluation were 91 digits in the 87 patients (mean age, 35 years; range, 14-54) who returned for outcome assessments 12 months after surgery.
  
  
  RESULTS
  Of 120 digits replanted, 115 digits survived, corresponding to an overall success rate of 96%. No patients received alternative means to alleviate venous congestion, such as leeches or other means of external bleeding. Nearly all of the 87 patients (91 digits) were satisfied with the results of the replantations.
  
  
  CONCLUSIONS
  Our technique reconstructs circulation without vein anastomosis in zone I replantation. This alternative to venous congestion involves a simple surgical procedure and straightforward postoperative care. Follow-up assessments of a series of 120 replantations show that the majority of zone I replantations led to satisfactory function. We therefore propose this technique as an effective method for zone I replantation.
  
  
  METHODS
  Therapeutic IV.
authors.affiliation: Hand Surgery, Second Hospital of Qinhuangdao, Changli, Qinhuangdao, Hebei, China. ahand@sina.com
authors.forename: Xu
authors.initials: X
authors.lastname: Zhang
authors.forename: Sumin
authors.initials: S
authors.lastname: Wen
authors.forename: Baoshi
authors.initials: B
authors.lastname: Wang
authors.forename: Qi
authors.initials: Q
authors.lastname: Wang
authors.forename: Chenglin
authors.initials: C
authors.lastname: Li
authors.forename: Hongwei
authors.initials: H
authors.lastname: Zhu
mesh_terms: D000293:Adolescent; D000328:Adult; D000673:Amputation, Traumatic / Q000601:surgery*; D000925:Anticoagulants / Q000627:therapeutic use; D001158:Arteries / Q000293:injuries / Q000601:surgery; D002648:Child; D002675:Child, Preschool; D005260:Female; D005383:Finger Injuries / Q000601:surgery*; D005385:Fingers / Q000098:blood supply* / Q000601:surgery*; D006801:Humans; D008026:Ligation; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D012092:Replantation / Q000379:methods*; D012189:Retrospective Studies; D055815:Young Adult
chemical_list: D000925:Anticoagulants