title: Abdominal Pocket Method as a Salvage Procedure for Vascular Insufficiency After Distal Digital Replantation.
abstract: OBJECTIVE
  To assess the utility of abdominal pocketing of a deepithelialized reattached digit to allow for neovascularization as a salvage procedure for circulatory insufficiency after digital replantation. We performed this method in Tamai zone II cases in which microsurgical vascular anastomosis was expected to be difficult based on the findings at the initial operation.
  
  
  METHODS
  From 2008 to 2014, 5 injured digits from 5 patients (mean age, 34 years; range: 25-54 years) underwent the abdominal pocket method as a salvage procedure for postoperative circulatory insufficiency. We evaluated the survival incidence, the timing between operations, and the duration of the second operation. During this study period, 7 amputated digits from 7 patients underwent vascular reanastomosis. We also evaluated the survival incidence for these cases.
  
  
  RESULTS
  Four out of 5 replanted digital tips survived. The mean time between the initial operation and the onset of vascular problems was 82 hours, and the mean duration of the second operation was 48 minutes. The survival incidence for reanastomosed cases was 6 out of 7.
  
  
  CONCLUSIONS
  The abdominal pocket method is useful for treating circulatory insufficiency after digital replantation in Tamai zone II cases in which microsurgical vascular reanastomosis was expected to be difficult based on the findings at the initial operation.
  
  
  METHODS
  Therapeutic IV.
authors.affiliation: Department of Plastic and Reconstructive Surgery, Kyowa Hospital, Kyoto, Japan. Electronic address: mail_jjsprs@yahoo.co.jp.
authors.forename: Seiji
authors.initials: S
authors.lastname: Sawai
authors.affiliation: Department of Plastic and Reconstructive Surgery, Kyowa Hospital, Kyoto, Japan.
authors.forename: Toshihiro
authors.initials: T
authors.lastname: Kitayama
authors.affiliation: Department of Plastic and Reconstructive Surgery, Kyowa Hospital, Kyoto, Japan.
authors.forename: Haruo
authors.initials: H
authors.lastname: Soeda
mesh_terms: D000328:Adult; D000673:Amputation, Traumatic / Q000601:surgery*; D005260:Female; D005383:Finger Injuries / Q000601:surgery*; D006801:Humans; D023821:Limb Salvage / Q000379:methods*; D008297:Male; D008866:Microsurgery / Q000379:methods*; D008875:Middle Aged; D016491:Peripheral Vascular Diseases / Q000209:etiology / Q000601:surgery*; D012092:Replantation / Q000009:adverse effects / Q000379:methods*; D016896:Treatment Outcome
keywords: Amputation; abdominal pocket method; digital replantation; salvage procedure