DECOMPRESSION AND DIVERTING EFFECTS OF VASCULAR ANASTOMOSIS BASED ON DIGITAL ARTERIAL ARCH BRANCH IN REPL ANTATION OF FREE FINGER-PULP_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

CHAILibing ¹ , LIUHongxia ² , LIUYuejiao ¹ , LULaijin ¹ ,  CUIJianli ¹

1. Department of Hand and Foot Surgery, the First Affiliated Hospital of Jilin University, Changchun Jilin, 130021, P. R. China;
2. Department of General Surgery, the First Affiliated Hospital of Xinxiang Medical College;

Corresponding?author：

CUIJianli, Email: tsuijianli@126.com

Keywords：

Digital replantation; Finger-pulp; Venous reflux

DOI：

10.7507/1002-1892.20160043

Video：

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Objective To investigate the decompression and diverting effects of vascular anastomosis based on the digital arterial arch branch in replantation of free finger-pulp in distal phalanges. Methods A retrospective analysis was performed on the clinical data of 12 patients (12 fingers) who underwent free finger-pulp replantation with anastomosis of proper palmar digital artery and the palmar digital artery arch branch in the distal end between December 2004 and March 2015. Of 12 cases, 9 were male and 3 were female, aged 15-39 years with an average of 32 years. The causes of injury included cutting injury in 4 cases, crush injury in 7 cases, and avulsion injury in 1 case. The thumb was involved in 2 cases, index finger in 4 cases, ring finger in 3 cases, middle finger in 1 case, and little finger in 2 cases. The free finger pulp ranged from 1.8 cm×1.5 cm to 2.8 cm×2.0 cm. The time from injury to operation ranged from 1.5 to 11.0 hours, with an average of 5.7 hours. No arterial arch or proper palmar digital arteriae anastomosis was excluded. Results Free finger-pulp survived in 11 cases after operation; venous crisis occurred in 1 case at 2 days after operation, and was cured after symptomatic treatment. Nine cases were followed up 6-18 months with an average of 10 months. The finger-pulp had good appearance, clear fingerprint, and soft texture. The two-point discrimination was 3.1-6.0 mm, with an average of 4.6 mm at 6 months after operation. The function of finger flexion and extension was normal. And according to upper extremity functional evaluation standard by hand surgery branch of Chinese Medical Association, the results were excellent in 7 cases, and good in 2 cases. Conclusion In the replantation of amputated pulp with insufficiency of venous blood outflow, the anastomosis of digital arterial arch branch in the distal end can decompress and shunt arterial blood, adjust blood inflow and outflow, and solve the problems of insufficient quantity of the vein and venous reflux disturbance.

Citation： CHAILibing, LIUHongxia, LIUYuejiao, LULaijin, CUIJianli. DECOMPRESSION AND DIVERTING EFFECTS OF VASCULAR ANASTOMOSIS BASED ON DIGITAL ARTERIAL ARCH BRANCH IN REPL ANTATION OF FREE FINGER-PULP. Chinese Journal of Reparative and Reconstructive Surgery, 2016, 30(2): 211-214. doi: 10.7507/1002-1892.20160043 Copy

1.	?田萬成, 潘希貴, 盧全中, 等. 指尖離斷分型與再植. 中國創傷骨科雜志, 2000, 2(3):197-198.
2.	江起庭, 江志偉, 楊麗娜. 指側方靜脈在指尖離斷再植中的應用. 中國修復重建外科雜志, 2013, 27(2):251-252.
3.	Hattori Y, Doi K, Ikeda K, et al. Significance of venous anastomosis in fingertip replantation. Plast Reconstr Surg, 2003, 111(3):1151-1158.
4.	王泉, 牛洪峰, 肖春來, 等. 吻合靜脈聯合改良動靜脈轉流術治療手指末節離斷傷. 中國骨與關節損傷雜志, 2015, 30(9):996-997.
5.	潘達德, 顧玉東, 侍德, 等. 中華醫學會手外科學會上肢部分功能評定試用標準. 中華手外科雜志, 2000, 16(3):130-135.
6.	Strauch B, de Moura W. Arterial system of the fingers. J Hand Surg (Am), 1990, 15(1):148-154.
7.	丁自海, 王昌德, 劉文寬, 等. 指尖的血管構筑. 解剖與臨床, 1999, 4(2):65-67.
8.	顧玉東, 王澍寰, 侍德. 手外科手術學. 2版. 上海:復旦大學出版社, 2010:726-771.
9.	吳克儉, 王富, 張建, 等. 指腹再植六例. 中華顯微外科雜志, 2005, 28(2):102.
10.	Chen YC, Chan FC, Hsu CC, et al. Fingertip replantation without venous anastomosis. Ann Plast Surg, 2013, 70(3):284-288.
11.	王相, 張威凱, 毛根蓮, 等. 吻合掌側靜脈且保留指甲的多指指尖離斷再植. 中國修復重建外科雜志, 2014, 28(3):391-392.
12.	Kamei K, Sinokawa Y, Kishibe M. The venocutaneous fistula:a new technique for reducing venous congestion in replanted fingertips. Plast Reconstr Surg, 1997, 99(6):1771-1774.
13.	Koshima I, Yamashita S, Sugiyama N, et al. Successful delayed venous drainage in 16 consecutive distal phalangeal replantations. Plast Reconstr Surg, 2005, 115(1):149-154.
14.	Hsu CC, Lin YT, Moran SL, et al. Arterial and venous revascularization with bifurcation of a single central artery:a reliable strategy for Tamai Zone I replantation. Plast Reconstr Surg, 2010, 126(6):2043-2051.
15.	姚保兵, 胡亮, 尹成國, 等. 指動脈靜脈化在手指末節離斷再植的療效分析. 中國臨床解剖學雜志, 2012, 30(6):705-707.
16.	楊中華, 周必光, 彭正人, 等. 經骨髓腔靜脈回流的指尖再植. 中華手外科雜志, 2002, 18(4):206-208.
17.	王群. 指動脈替代回流在靜脈缺損的末節斷指再植中的應用分析. 中華創傷骨科雜志, 2006, 8(6):583-584.
18.	宋溦, 黃東, 邱斌, 等. 缺乏可吻合靜脈的末節斷指再植的研究進展. 中國臨床解剖學雜志, 2015, 33(1):111-112.
19.	Cheng GL, Pan DD, Yang ZX, et al. Replantation of digits amputated at or about the distal interphalangeal joint. Ann Plast Surg, 1985, 15(6):465-473.

1. ?田萬成, 潘希貴, 盧全中, 等. 指尖離斷分型與再植. 中國創傷骨科雜志, 2000, 2(3):197-198.
2. 江起庭, 江志偉, 楊麗娜. 指側方靜脈在指尖離斷再植中的應用. 中國修復重建外科雜志, 2013, 27(2):251-252.
3. Hattori Y, Doi K, Ikeda K, et al. Significance of venous anastomosis in fingertip replantation. Plast Reconstr Surg, 2003, 111(3):1151-1158.
4. 王泉, 牛洪峰, 肖春來, 等. 吻合靜脈聯合改良動靜脈轉流術治療手指末節離斷傷. 中國骨與關節損傷雜志, 2015, 30(9):996-997.
5. 潘達德, 顧玉東, 侍德, 等. 中華醫學會手外科學會上肢部分功能評定試用標準. 中華手外科雜志, 2000, 16(3):130-135.
6. Strauch B, de Moura W. Arterial system of the fingers. J Hand Surg (Am), 1990, 15(1):148-154.
7. 丁自海, 王昌德, 劉文寬, 等. 指尖的血管構筑. 解剖與臨床, 1999, 4(2):65-67.
8. 顧玉東, 王澍寰, 侍德. 手外科手術學. 2版. 上海:復旦大學出版社, 2010:726-771.
9. 吳克儉, 王富, 張建, 等. 指腹再植六例. 中華顯微外科雜志, 2005, 28(2):102.
10. Chen YC, Chan FC, Hsu CC, et al. Fingertip replantation without venous anastomosis. Ann Plast Surg, 2013, 70(3):284-288.
11. 王相, 張威凱, 毛根蓮, 等. 吻合掌側靜脈且保留指甲的多指指尖離斷再植. 中國修復重建外科雜志, 2014, 28(3):391-392.
12. Kamei K, Sinokawa Y, Kishibe M. The venocutaneous fistula:a new technique for reducing venous congestion in replanted fingertips. Plast Reconstr Surg, 1997, 99(6):1771-1774.
13. Koshima I, Yamashita S, Sugiyama N, et al. Successful delayed venous drainage in 16 consecutive distal phalangeal replantations. Plast Reconstr Surg, 2005, 115(1):149-154.
14. Hsu CC, Lin YT, Moran SL, et al. Arterial and venous revascularization with bifurcation of a single central artery:a reliable strategy for Tamai Zone I replantation. Plast Reconstr Surg, 2010, 126(6):2043-2051.
15. 姚保兵, 胡亮, 尹成國, 等. 指動脈靜脈化在手指末節離斷再植的療效分析. 中國臨床解剖學雜志, 2012, 30(6):705-707.
16. 楊中華, 周必光, 彭正人, 等. 經骨髓腔靜脈回流的指尖再植. 中華手外科雜志, 2002, 18(4):206-208.
17. 王群. 指動脈替代回流在靜脈缺損的末節斷指再植中的應用分析. 中華創傷骨科雜志, 2006, 8(6):583-584.
18. 宋溦, 黃東, 邱斌, 等. 缺乏可吻合靜脈的末節斷指再植的研究進展. 中國臨床解剖學雜志, 2015, 33(1):111-112.
19. Cheng GL, Pan DD, Yang ZX, et al. Replantation of digits amputated at or about the distal interphalangeal joint. Ann Plast Surg, 1985, 15(6):465-473.

Chinese Journal of Reparative and Reconstructive Surgery

DECOMPRESSION AND DIVERTING EFFECTS OF VASCULAR ANASTOMOSIS BASED ON DIGITAL ARTERIAL ARCH BRANCH IN REPL ANTATION OF FREE FINGER-PULP

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