title: Lateral Nail Fold Incision Technique for Venous Anastomosis in Fingertip Replantation.
abstract: BACKGROUND
  Successful venous anastomosis is one of the most important factors in fingertip replantation. Volar veins in the fingertip course proximally in a random pattern, which makes it difficult to find out the exact locations. Although dorsal veins in the lateral nail fold have constant location and adequate diameter for anastomosis, they have been known as hard to dissect from the immobile subcutaneous tissue. The authors present a new lateral nail fold incision technique for venous anastomosis in the fingertip amputations.
  
  
  METHODS
  From February 2010 to October 2010, 9 replantations using the new incision and venous anastomosis technique were performed in 9 patients. The levels of amputations were from the nail base to half of the nail bed. After repairing the proper digital arteries, a skin incision was made along the junction between the lateral nail fold and nail bed. Careful dissection was performed to isolate the veins in the lateral nail fold. After evaluation of the suitability of the vessel, venous anastomosis was performed.
  
  
  RESULTS
  Seven male and 2 female patients were enrolled in this study. Appropriate dorsal veins for anastomosis could be found in 8 of 9 patients. All the replanted stumps survived without venous congestion and following additional procedures. A sizable volar or dorsal vein could not be found in 1 patient. The salvage technique was required in this patient.
  
  
  CONCLUSIONS
  Dorsal veins in the lateral nail fold can be found easily because of the constant anatomical location. The new incision on the lateral nail fold provides not only sufficient operative field for anastomosis but also additional opportunity of successful venous anastomosis in the selected cases. The authors, therefore, propose this technique as an effective method for an alternative venous anastomosis in the zone I replantation.
authors.affiliation: From the *Department of Plastic Surgery, Korea University Medical Center, Ansan-si; †Gangnam Jaejun Hand and Plastic Clinic, Pyeongtaek-si; ‡Department of Plastic Surgery, Gwang Myeong Seong-Ae General Hospital, Gwangmyeong-si, Gyeonggi-do; and §Department of Plastic Surgery, Inha University School of Medicine, Incheon, Republic of Korea.
authors.forename: Byung-Joon
authors.initials: BJ
authors.lastname: Jeon
authors.forename: Jae-Won
authors.initials: JW
authors.lastname: Yang
authors.forename: Si Young
authors.initials: SY
authors.lastname: Roh
authors.forename: Sae Hwi
authors.initials: SH
authors.lastname: Ki
authors.forename: Dong Chul
authors.initials: DC
authors.lastname: Lee
authors.forename: Jin Soo
authors.initials: JS
authors.lastname: Kim
mesh_terms: D000328:Adult; D000673:Amputation, Traumatic / Q000601:surgery*; D000714:Anastomosis, Surgical; D015331:Cohort Studies; D005260:Female; D005383:Finger Injuries / Q000601:surgery*; D005385:Fingers / Q000098:blood supply / Q000601:surgery*; D005500:Follow-Up Studies; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D008875:Middle Aged; D009262:Nails / Q000601:surgery; D020127:Recovery of Function; D012092:Replantation / Q000379:methods*; D018570:Risk Assessment; D016896:Treatment Outcome; D014680:Veins / Q000601:surgery; D014945:Wound Healing / Q000502:physiology