Secondary subdermal pocket procedure for venous insufficiency after digital replantation/revascularization.
OBJECTIVE
Venous insufficiency after microsurgical replantation/revascularization remained to be a vexing problem for finger failure, despite the level of amputation. Other than redo the venous anastomosis, alternative methods such as subdermal pocket procedure (SDP) can be used. The aim of this study was to incorporate SDP immediately at the time of replantation, when no suitable vein is available after digital artery anastomosis; or, as a secondary salvage procedure to restore venous drainage for venous insufficiency after initial digital replantation/revascularization.


METHODS
From 1999 to 2010, a total of 21 injured digits from 20 patients were collected. The mechanisms of injury included 6 guillotine amputations, 1 guillotine near-complete amputation, 12 crushing amputations, 1 crushing injury, and 1 crushing injury with contact thermal burn. The average patients' age was 34.5 years. Subdermal pocket procedures were used to all injured digits at different time frame as indicated. The patients were divided into 2 groups based on the timing of SDP, either primary or secondary. The pocketing period and the time lapse between the initial operation and the secondary salvaged SDP were also documented.


RESULTS
Group 1 (13 digits) received primary SDP as means of venous drainage immediately after digital artery revascularization. The mean pocketing period was 9.2 days, ranging from 7 to 15 days, with a 100% complete survival rate. Group 2 (8 digits) received secondary SDP as a salvage procedure when venous congestion became apparent later. The mean time lapse between initial operation and salvaged SDP was 53.1 hours. The average pocketing period was 7.5 days, with a 75% survival rate.


CONCLUSIONS
Secondary SDP provides an alternative salvage solution for postreplantation venous insufficiency without the need for further microsurgery.
From the Department of Plastic and Reconstructive Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.
Tsan-Shiun
TS
Lin
Johnson Chia-Shen
JC
Yang
D000293:Adolescent; D000328:Adult; D000673:Amputation, Traumatic / Q000601:surgery*; D001158:Arteries / Q000601:surgery; D002648:Child; D002675:Child, Preschool; D005260:Female; D005383:Finger Injuries / Q000601:surgery*; D005385:Fingers / Q000098:blood supply* / Q000601:surgery; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D008297:Male; D008866:Microsurgery / Q000379:methods*; D008875:Middle Aged; D011183:Postoperative Complications / Q000601:surgery*; D012092:Replantation / Q000379:methods*; D016879:Salvage Therapy / Q000379:methods; D016896:Treatment Outcome; D014689:Venous Insufficiency / Q000209:etiology / Q000601:surgery*; D055815:Young Adult