Arterial and venous revascularization with bifurcation of a single central artery: a reliable strategy for Tamai Zone I replantation.
BACKGROUND
Replantation of the distal phalanx and pulp can be performed to improve finger function and finger aesthetics; however, establishing adequate venous drainage is a challenge. Slattery et al. reported microsurgical reattachment of a partial distal phalanx with the use of a bifurcated terminal digital artery. The bifurcation was divided into two pedicles, one of which was used for venous drainage. In this article, the authors report their experience with a similar technique and propose a new algorithm for distal finger replantation.


METHODS
From January of 2008 to February of 2009, five replantations were performed using a single central artery. The replanted levels were pulp, avulsed fingertip of the thumb, and distal phalanges. There was no volar vein, dorsal vein, or second artery available in the amputated part for standard venous drainage. Venous drainage in all cases was established by creating an anastomosis from a branch of the solitary terminal artery to a recipient vein.


RESULTS
All digits were replanted successfully without evidence of arterial insufficiency or venous congestion. Partial necrosis was not identified postoperatively in any of the five fingers. There were no cases of wound infection.


CONCLUSIONS
A branch of the central solitary artery may be used successfully to reestablish venous outflow in cases of distal finger tip replantation. This technique allowed for the salvage of all fingers in this study without the use of leeches or other techniques used in cases of venous insufficiency.
Taipei, Taiwan; and Rochester, Minn. From the Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Chang Gung Medical College, Chang Gung University, and the Division of Plastic Surgery, Department of Orthopedic Surgery, Mayo Clinic.
Chung-Chen
CC
Hsu
Yu-Te
YT
Lin
Steven L
SL
Moran
Cheng-Hung
CH
Lin
Fu-Chan
FC
Wei
Chih-Hung
CH
Lin
D000328:Adult; D000673:Amputation, Traumatic / Q000601:surgery*; D001158:Arteries / Q000601:surgery; D002675:Child, Preschool; D005260:Female; D005383:Finger Injuries / Q000601:surgery*; D005385:Fingers / Q000098:blood supply*; D006801:Humans; D008297:Male; D008866:Microsurgery / Q000379:methods*; D008875:Middle Aged; D012092:Replantation / Q000379:methods*; D013933:Thumb / Q000098:blood supply / Q000293:injuries* / Q000601:surgery; D014680:Veins / Q000601:surgery