Clinical research on reconstruction of venous return during fingertip replantation of I subarea

Gao Huiqin; Jiang Qiting; Ding Zihan

doi:10.3969/j.issn.1672-8521.2016.04.005

Abstract：Objective: To investigate the clinical effects of using the venous translation of single central artery bifurcation technique for distal fingertip replantation.Methods: The data of 27 patients with Tamai's zone I distal fingertip amputation admitted to the hospital from September 2013 to February 2015 was retrospectively analyzed. They received replantation of amputated finger with the venous translation of single central artery bifurcation technique. There were 16 males and 11 females, aged 18-51 years with a median of 31.4 years. Among them, the thumb was involved in 3 cases, the index finger in 9, the middle finger in 7, the ring finger in 5, and the little finger in 3. The causes of injury were machinery twisting injury in 13 cases, crush injury in 11, and chainsaw injury in 3. There was no volar vein, dorsal vein, or second artery available from the amputated part for standard venous drainage.Results: All the fingers were replanted successfully without evidence of arterial insufficiency or venous congestion. All the wounds healed by first intention, and partial necrosis was not seen postoperatively in any finger. Twenty-five patients were followed up for 6 to 20 months (average, 13.3 months) . At the final follow-up, the finger appearance was satisfactory, nails were smooth, and no obvious atrophy of finger was found. The fingerpulp mean value of static 2-point discrimination was 5.4 mm (range, 4.5-6.5 mm) . In our series, based on the Michigan Hand Outcome Questionnaire, 21 patients were strongly satisfied with the injured finger appearance and 4 satisfied with the appearance.Conclusions: The single central artery bifurcation technique, which can be used safely, with high survival rate and promote growth of nail, can be an ideal choice when there is no volar vein, dorsal vein, or second artery available in the amputated part for standard venous drainage.