2012 Volume 25 Issue 1 Pages 59-64
Successful replantation is an ideal treatment for fingertip amputation. However, reestablishment of venous outflow is often difficult because the volar vein in the fingertip is very small. Several techniques have been described to obtain satisfactory outflow from replants. However, these techniques are not always applicable.
When reestablishment of venous outflow is impossible, we intentionally reduce the pulp volume of the replant, excising pulp tissues to the center of the fingerprint of the distal phalanx and anastomose a digital artery as distally as possible. We applied this technique in eleven cases, and the graft survived in ten of these cases. We performed artery-only replantation with this intentional volume reduction technique, and the success rate was 90%.
Fingertip replantation with artery-only anastomosis in Ishikawa's subzone 1 and 2 was reported to show a higher success rate than those in subzones 3 and 4. These observations indicated that a smaller replant volume is associated with a higher rate of successful replantation similar to composit grafts.
We hypothesize that a small-volume replant may survive as a composite graft with supercharging artery inflow. This technique may be useful as a last choice for artery-only fingertip replantation when reestablishment of venous drainage is impossible.
