Bridging the gap in hand replantation: use of the common digital artery for completion of the superficial palmar arch.
BACKGROUND
Traumatic hand amputations along a longitudinal axis are possible but, to the authors' knowledge, have not been described in the literature. To bridge the gap and repair the transected superficial palmar arch at its apex, a common digital artery can be sacrificed and turned toward the plane of the arch. An anatomical study was performed to investigate the possibility of using the common digital artery to the third web space for completion of the superficial palmar arch.


METHODS
Fifteen fresh cadaveric hands were dissected to evaluate the caliber and origin of the common digital artery to the third web space for possible reconstitution of the arch.


RESULTS
In all specimens, a complete superficial palmar arch was identified. In 10 specimens, the superficial palmar arch caliber tapered off from the ulnar to the radial aspect, indicating an anatomical ulnar dominance of the arch. The average diameter of the common digital artery to the third web space was 1.7±0.2 mm. The average superficial palmar arch diameter measured 1.6±0.7 mm on the radial side of the common digital artery. In two female cadaver specimens, a unique pattern in the origin of the common digital artery was identified. The common digital artery to the second and third web spaces originated from a common branch off of the superficial palmar arch.


CONCLUSIONS
Replantation of a longitudinally amputated hand can be performed based solely on a common digital artery for reconstitution of palmar arch flow. However, because of known variability in the palmar arch configuration, intraoperative clamping must be used to ensure safe use of the donor vessels while avoiding distal ischemic risk.
Louisville, Ky.; and San Francisco, Calif. From the Division of Plastic Surgery, University of Louisville School of Medicine, and The Buncke Clinic.
Ron
R
Hazani
Josh
J
Elston
Darrell
D
Brooks
Bradon J
BJ
Wilhelmi
D000673:Amputation, Traumatic / Q000473:pathology / Q000601:surgery*; D001158:Arteries / Q000473:pathology / Q000601:surgery; D005260:Female; D006225:Hand / Q000098:blood supply*; D006230:Hand Injuries / Q000473:pathology / Q000601:surgery*; D006801:Humans; D007511:Ischemia / Q000517:prevention & control; D008297:Male; D008866:Microsurgery / Q000379:methods*; D012016:Reference Values; D012092:Replantation / Q000379:methods*; D014680:Veins / Q000637:transplantation; D055815:Young Adult