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Ozcelik IB, Kabakas F, Mersa B, Purisa H, Sezer I, Jusoh MH. Single- versus double-artery repair without vein anastomosis in Tamai I fingertip replantations: a retrospective cohort study. J Hand Surg Eur Vol 2025; 50:208-213. [PMID: 39169767 DOI: 10.1177/17531934241264651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/23/2024]
Abstract
LEVEL OF EVIDENCE III.
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Affiliation(s)
- Ismail Bulent Ozcelik
- Yeniyuzyil University Gaziosmanpasa Hospital, Department of Hand and Reconstructive Microsurgery, Istanbul, Turkiye
- School of Health Sciences, Nisantasi University, Istanbul, Turkiye
| | - Fatih Kabakas
- Hand Surgery Unit, Gebze Medical Park Hospital, Turkiye
| | - Berkan Mersa
- Yeniyuzyil University Gaziosmanpasa Hospital, Department of Hand and Reconstructive Microsurgery, Istanbul, Turkiye
- School of Health Sciences, Nisantasi University, Istanbul, Turkiye
| | | | - Ilker Sezer
- Hand Surgery Unit, Bahcesehir Liv Hospital, Turkiye
| | - Mohd Hanifah Jusoh
- Hand & Microsurgery Unit, Department of Orthopaedics, School of Medical Sciences, Universiti Sains Malaysia, Kelantan, Malaysia
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Abualadas H. Replantation of middle fingertip following complete Tamai Zone 2 amputation and eschar development: A clinical case report. Int J Surg Case Rep 2025; 126:110664. [PMID: 39612904 PMCID: PMC11647792 DOI: 10.1016/j.ijscr.2024.110664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2024] [Accepted: 11/23/2024] [Indexed: 12/01/2024] Open
Abstract
INTRODUCTION Fingertip injuries are common, and proper management depends on the type of injury and the long-term function. This case report presents a challenging fingertip replantation of the middle finger with single artery anastomosis, which was complicated by an eschar and progressed to healing after six months of post-operative care. CASE PRESENTATION A 27-year-old man came with a left middle fingertip amputation distal to the distal interphalangeal joint (Tamai zone 2). After careful assessment, replantation was done with anastomosis of one digital artery and no venous anastomosis. The follow-up period ranged from 1 to 6 months. At one month, the nail plate fell, and eschar developed. Subsequently, eschar fell, and a new nail had grown after 3 months of repair. A follow-up after 6 months revealed a healed middle finger with good cosmetic and functional outcomes. CLINICAL DISCUSSION Replantation of Tamai zone 2 fingertip amputation of the middle finger can be challenging, especially with damaged digital veins like in our case. However, we opted for replantation with one arterial anastomosis only, to preserve the length and function of the digit. In the literature, there were cases of artery-only replantations that had successful outcomes. However, an eschar complicated our case, and smoking contributed to its development. CONCLUSION This case shows a successful replantation with one arterial anastomosis and no venous anastomosis after eschar development. Also, it underscores the importance of post-operative care, anatomical knowledge, and physician's expertise to achieve a successful replantation.
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Affiliation(s)
- Hana Abualadas
- Family and Child Health Care Clinic, Primary Care, Amman, Jordan; Mercer University School of Medicine, Columbus, GA, USA.
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Hara T, Kurimoto S, Kurahashi T, Kuwahara Y, Takeshige H, Urata S. Limiting Levels of Fingertip Replantation Without Venous Anastomosis. J Hand Surg Am 2024; 49:1274.e1-1274.e6. [PMID: 37256249 DOI: 10.1016/j.jhsa.2023.04.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Revised: 03/27/2023] [Accepted: 04/12/2023] [Indexed: 06/01/2023]
Abstract
PURPOSE This study aimed to compare the success rates of fingertip replantation with and without venous anastomosis. METHODS This retrospective study included 132 patients with 148 fingertip injuries who had undergone fingertip replantation (Ishikawa's classification I‒IV) between 2003 and 2020 at our hospital. Among them, 117 and 15 were men and women respectively, and their mean age was 43 years. There were 53, 44, and 51 fingertips with Ishikawa subzone II, III, and IV amputations respectively, and no cases were classified as Ishikawa subzone I. Venous anastomosis was performed on 64 fingertips (group A). This was not possible in the remaining 84 fingertips; thus, an external bleeding method was used (group B). Our external bleeding protocol consisted of 4-hourly skin pricks of the distal pulp with a 23-gauge needle for the first 5 days. The analyses included survival rates, hemoglobin levels (Hb), and blood transfusions administered. RESULTS The overall survival rate was 90.5% (134 of 148). In group A, survival was achieved in 92.3%, 100%, and 94.3% of those with subzones II, III, and IV amputations, respectively. In group B, survival was achieved in 100%, 82.1%, and 62.5% of those with subzones II, III, and IV, respectively. Subzone IV in group B showed a significantly lower rate of replantation success. In groups A and B, the preoperative and 7-day postoperative Hb levels were 14.5 g/dL and 14.6 g/dL, and 11.3 g/dL, and 11.6 g/dL, respectively. In addition, blood transfusion was required for five patients (7.9%) in group A and six patients (7.9%) in group B. Thus, the Hb levels and blood transfusion administered were similar between the two groups. CONCLUSIONS Subzone IV is an important threshold for artery-only replantation. Furthermore, our external bleeding protocol is a safe and effective method. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic IV.
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Affiliation(s)
- Tatsuya Hara
- Department of Orthopedic Surgery, Anjo Kosei Hospital, Anjo, Japan.
| | - Shigeru Kurimoto
- Department of Hand Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | | | - Yutaro Kuwahara
- Department of Orthopedic Surgery, Anjo Kosei Hospital, Anjo, Japan
| | - Hiroki Takeshige
- Department of Orthopedic Surgery, Anjo Kosei Hospital, Anjo, Japan
| | - Shiro Urata
- Department of Orthopedic Surgery, Anjo Kosei Hospital, Anjo, Japan
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Fijany AJ, Chaker SC, Egozi HP, Hung YC, Hill BJ, Bhandari L, Thayer WP, Lineaweaver WC. Amputated Digit Replantations: Critical Digit Ischemia Timing, Temperature, and Other Predictors of Survival. Ann Plast Surg 2024; 92:667-676. [PMID: 38725110 DOI: 10.1097/sap.0000000000003944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/21/2024]
Abstract
INTRODUCTION A common consideration for replantation success is the ischemia time following injury and the preservation temperature. A classic principle within the hand surgery community describes 12 hours of warm ischemia and 24 hours of cold ischemia as the upper limits for digit replantation; however, these limits are largely anecdotal and based on older studies. We aimed to compare survival data from the large body of literature to aid surgeons and all those involved in the replantation process in hopes of optimizing success rates. METHODS The PubMed database was queried on April 4th, 2023, for articles that included data on digit replantation survival in terms of temperature of preservation and ischemia time. All primary outcomes were analyzed with the Mantel-Haenszel method within a random effects model. Secondary outcomes were pooled and analyzed using the chi-square statistic. Statistical analysis and forest plot generation were completed with RevMan 5.4 software with odds ratios calculated within a 95% confidence interval. RESULTS Our meta-analysis identified that digits preserved in cold ischemia for over 12 hours had significantly higher odds of replantation success than the amputated digits replanted with 0-12 hours of warm ischemia time ( P ≤ 0.05). The odds of survival in the early (0-6 hours) replantation group were around 40% greater than the later (6-12 hours) replantation group ( P ≤ 0.05). Secondary outcomes that were associated with higher survival rates included a clean-cut amputation, increased venous and arterial anastomosis, a repair that did not require a vein graft, and replants performed in nonsmokers ( P ≤ 0.05). DISCUSSION Overall, these findings suggest that when predicting digit replantation success, time is of the essence when the digit has yet to be preserved in a cold environment. This benefit, however, is almost completely diminished when the amputated digit is appropriately maintained in a cold environment soon after injury. In conclusion, our results suggest that there is potential for broadening the ischemia time limits for digit replant survival outlined in the literature, particularly for digits that have been stored correctly in cold ischemia.
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Affiliation(s)
- Arman J Fijany
- From the Department of Plastic Surgery, Vanderbilt University Medical Center, Nashville, TN
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Pugliese P, De Francesco F, Pangrazi PP, De Francesco M, Santanelli di Pompeo F, Riccio M. Tamai zone -I and -II replantation versus reconstruction with local flaps: retrospective analysis for functional and cosmetic results. Case Reports Plast Surg Hand Surg 2024; 11:2320882. [PMID: 38415206 PMCID: PMC10898269 DOI: 10.1080/23320885.2024.2320882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 02/15/2024] [Indexed: 02/29/2024]
Abstract
A retrospective study were presented to compare functional and cosmetic outcomes in relation to local flap reconstruction or fingertip replantation in cases of zones I and II amputation. Outcomes were evaluated using Semmens Weinstein monofilament, Weber DiskCriminator, total active motion (TAM) assessment and Michigan Hand Questionnaire after a 1-year follow-up.
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Affiliation(s)
- Pierfrancesco Pugliese
- Department of Reconstructive Surgery and Hand Surgery, AOU "Ospedali Riuniti", Ancona, Italy
- Department of Surgical, Oncological and Oral Sciences, Section of Plastic and Reconstructive Surgery, University of Palermo, Palermo, Italy
| | - Francesco De Francesco
- Department of Reconstructive Surgery and Hand Surgery, AOU "Ospedali Riuniti", Ancona, Italy
| | - Pier Paolo Pangrazi
- Department of Reconstructive Surgery and Hand Surgery, AOU "Ospedali Riuniti", Ancona, Italy
| | | | - Fabio Santanelli di Pompeo
- Plastic Surgery Unit, NESMOS Department, Faculty of Medicine and Psychology, University Sapienza of Rome, Rome, Italy
| | - Michele Riccio
- Department of Reconstructive Surgery and Hand Surgery, AOU "Ospedali Riuniti", Ancona, Italy
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Lu YM, Lin YT, Tsai CH, Pan CH, Chen HH, Lee MC. Prognostic Factors for Attempted Finger Replantation and Revascularisation after Traumatic Amputation: A 16-Year Retrospective Cohort Study. J Hand Surg Asian Pac Vol 2023; 28:149-155. [PMID: 37120311 DOI: 10.1142/s242483552350025x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
Abstract
Background: The aim of this study was to evaluate the impact of variant factors on finger replantation and revascularisation after traumatic amputation, which also included duty shift and the level of main operator. Methods: To determine the prognostic factors for the survival rate of finger replantation and revascularisation after traumatic finger amputation, we retrospectively reviewed the cases of finger replantation conducted from January 2001 to December 2017. Data collected consisted of the basic information of the patients, trauma-related factors, details of the operation and treatment outcomes. Descriptive statistics and data analysis was performed to assess outcomes. Results: In total, 150 patients with 198 replanted digits were enrolled in this study. The median age of the participants was 42.5 years, and 132 (88%) patients were men. The overall successful replantation rate was 86.4%. Seventy-three (36.9%) digits had Yamano type 1 injury; 110 (55.6%), Yamano type 2 injury and 15 (7.6%), Yamano type 3 injury. In total, 73 (36.9%) digits were completely amputated and 125 (63.1%) were not. Half of the replantation procedures (101, 51.0%) were performed during night shift (16:00-00:00), 69 (34.8%) during day shift (08:00-16:00) and 28 (14.1%) during graveyard shift (00:00-08:00). Multivariate logistic regression demonstrated that the trauma mechanism and type of amputation (complete vs. incomplete) significantly affect the survival rate of replantation. Conclusions: The trauma mechanism and type of amputation (complete vs. incomplete) significantly affect the survival rate of replantation. Other factors including duty shift and the level of operator did not reach statistically significance. Further studies must be conducted to validate the results of the current study. Level of Evidence: Level III (Prognostic).
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Affiliation(s)
- Yi-Min Lu
- TaoYuan General Hospital, Minister of Health and Welfare, Taoyuan, Taiwan
| | - Yu-Te Lin
- Chang Gung Memorial Hospital, Keelung, Taiwan
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Tuluy Y, Aksoy A, Sir E. Effects of external bleeding and hyperbaric oxygen treatment on Tamai zone 1 replantation. Diving Hyperb Med 2023; 53:2-6. [PMID: 36966516 PMCID: PMC10318177 DOI: 10.28920/dhm53.1.2-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Accepted: 12/08/2022] [Indexed: 03/29/2023]
Abstract
INTRODUCTION Tamai zone 1 replantation poses a challenge due to the very small size of the vascular structures; often there is no vein for anastomosis. Replantation may have to be done with only an arterial anastomosis. In our study, we aimed to evaluate the success of replantation by combining external bleeding and hyperbaric oxygen treatment (HBOT) in Tamai zone 1 replantation. METHODS Between January 2017 and October 2021, 17 finger replantation patients who underwent artery-only anastomosis due to Tamai zone 1 amputation received 20 sessions of HBOT with external bleeding after the 24th postoperative hour. Finger viability was assessed at the end of treatment. A retrospective review of outcomes was performed. RESULTS Seventeen clean-cut finger amputation patients were operated on under digital block anaesthesia with a finger tourniquet. No blood transfusion was required. In one patient, complete necrosis developed and stump closure was performed. Partial necrosis was observed in three patients and healed secondarily. Replantation in the remaining patients was successful. CONCLUSIONS Vein anastomosis is not always possible in fingertip replantation. In Tamai zone 1 replantation with arteryonly anastomosis, post-operative HBOT with induced external bleeding appeared to shortened the hospital stay and was associated with a high proportion of successful outcomes.
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Affiliation(s)
- Yavuz Tuluy
- Department of Plastic Reconstructive and Aesthetic Surgery, Turgutlu State Hospital, Manisa, Turkey
- Corresponding author: Dr Yavuz Tuluy, Plastic, Reconstructive and Aesthetic Surgery, Manisa Turgutlu State Hospital, Turgutlu, Manisa, 45000, Turkey
| | - Alper Aksoy
- Konur Hospital, Department of Plastic Reconstructive and Aesthetic Surgery, Bursa, Turkey
| | - Emin Sir
- İzmir Kavram Vocational School, Department of Plastic Reconstructive and Aesthetic Surgery, İzmir, Turkey
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Zhou X, Sun D, Liu F, Li WJ, Gu C, Zhang LL. A mini hallux neurovascular osteo-onychocutaneous free flap for refined reconstruction of distal defects in thumbs and fingers. J Plast Surg Hand Surg 2023; 57:415-421. [PMID: 36495035 DOI: 10.1080/2000656x.2022.2147695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Distal injury in thumbs and fingers is common in emergency. Although multiple surgical techniques have been introduced for repair purpose, it is still challenging for restoring both good function and cosmetic appearance. The present study reports our experiences on how to reconstruct amputated fingertips in thumbs and fingers using a mini hallux neurovascular osteo-onychocutaneous free flap with favorable outcomes in 15 patients (average age, 27.27 ± 5.43 years old). Follow-up period was 19.47 ± 10.18 months (range, 6-48 months). Digital function was improved indicated by the static two-point discrimination (2-PD) and key-pinch, which were 8.40 ± 1.64 mm (range, 6-12 mm) and 85.37 ± 3.03% (range, 80.2-90.6%) of that of the intact contralateral thumbs and fingers, respectively, after surgery. As to aesthetic outcomes, all reconstructed digits were self-graded as good by patients. 73.3% of the donor halluces were self-graded as good and four halluces (26.7%) were graded as fair. In conclusion, the mini hallux neurovascular osteo-onychocutaneous flap may be used for refined reconstruction of type I amputated injury in thumbs and fingers achieving both satisfactory functional and aesthetic outcomes.
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Affiliation(s)
- Xianyu Zhou
- Department of Plastic & Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
| | - Di Sun
- Department of Plastic & Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
| | - Fei Liu
- Department of Plastic & Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
| | - Wen Jun Li
- Department of Hand Surgery, Shanghai Zhongye Hospital, Shanghai, People's Republic of China
| | - Chuan Gu
- Department of Hand Surgery, Shanghai Zhongye Hospital, Shanghai, People's Republic of China
| | - Ling Ling Zhang
- Department of Hand Surgery, Shanghai Zhongye Hospital, Shanghai, People's Republic of China
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Pamuk Ç. Supermicrosurgical Experience pertaining to Replantation of Tamai Zone 1 Fingertip Amputations. HANDCHIR MIKROCHIR P 2023; 55:28-34. [PMID: 36041461 DOI: 10.1055/a-1894-7320] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
With the advent of supermicrosurgery, the replantation of very distal finger amputations has become possible. The choice between replantation or flap surgeries in the treatment of Tamai Zone I finger amputations continues to be a matter of debate. This study aims to evaluate replantation results in Tamai Zone 1 finger amputations. The demographic characteristics and clinical results of 39 patients undergoing replantation for a Tamai Zone 1 finger amputation between 2018 and 2021 were retrospectively analyzed. The Cold Intolerance Severity Score (CISS), two-point discrimination test (2-PD) and Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) were calculated and recorded after a minimum follow-up period of 6 months. The great majority of patients were males (92.3%, n=36) who had suffered the injuries during work accidents (89.7%, n=35). The socioeconomic status of the patients showed a homogeneous distribution. Replant survival was achieved in 69.2% (n=27) of all fingers. The duration of the surgical procedure in patients who underwent vein repair was significantly longer (p<0.001). However, there was no significant relationship between vein repair and survival rate (p=0.348). This study shows that replantation is a surgical intervention that should be given priority in patients with Tamai Zone 1 amputations. In most cases of unsuccessful replantation, secondary recovery results are also acceptable. Future studies with larger case series are needed.
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Affiliation(s)
- Çağdaş Pamuk
- Orthopaedics and Traumatology Department, Private Silivri Anadolu Hospital, Silivri, Turkey
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Lu Y, Wang B, Liu H, Zhang N, Gu J. Improved Abdominal Hypodermal Pocket for Salvage of the Amputated Fingertip (Tamai Zone I). Indian J Surg 2022. [DOI: 10.1007/s12262-021-03120-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Negative-Pressure Wound Therapy Application in Fingertip Replantations and a Systematic Review. Plast Reconstr Surg 2022; 149:38e-47e. [PMID: 34936614 DOI: 10.1097/prs.0000000000008628] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Fingertip replantation is technically challenging. Venous congestion is one of the most common causes of replantation failure. Therefore, various venous drainage procedures and salvage techniques have been used in venous congestion. Negative-pressure wound therapy has proven beneficial in limb injuries, yet limited studies of fingertip replantation exist. This study aims to analyze risk factors in fingertip replantation and to evaluate the feasibility and clinical benefits of negative-pressure wound therapy compared with other salvage techniques. METHODS From January of 2015 to December of 2019, 27 patients (27 digits) who experienced fingertip amputation over Tamai zone I or II underwent replantation. Salvage negative-pressure wound therapy was applied for venous congestion postoperatively. Replantation data were collected for further analysis. RESULTS The overall survival rate of digit replantation with salvage negative-pressure wound therapy was 92.6 percent (25 of 27). The blood transfusion rate was 11.1 percent (three of 27). The average hospitalization time was 8.04 ± 1.43 days and the median duration of negative-pressure wound therapy was 6 days (range, 4 to 8 days; interquartile range, 2 days). There is no significant difference between the survival and failure groups for all risk factors evaluated. CONCLUSION Negative-pressure wound therapy is a simple and effective salvage option to relieve venous congestion in fingertip replantation with a satisfactory survival rate, low blood transfusion rate, and short inpatient stay. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, IV.
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Özdemir FDM, Uzun H, Özdemir E, Aksu AE. Comparative assessment of fingertip replantation in paediatric and adult patients within a single institution. J Hand Surg Eur Vol 2021; 46:877-882. [PMID: 33757326 DOI: 10.1177/17531934211002476] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The purpose of this retrospective study was to compare the outcomes of paediatric and adult fingertip replantation within a single institution. Our retrospective study found no significant difference in the survival rate between the paediatric (10/12) and adult (22/26) groups. At 6 months follow-up, there was no significant difference in sensory recovery between both groups, as measured with Semmes-Weinstein testing, but a significant difference in mean static two-point discrimination testing values between the paediatric (4.0 mm) and adult (6.2 mm) groups. Moreover, the mean time for regaining sensation was faster in paediatric patients (1.3 months) as compared with adult patients (4.1 months). Five children and four adults received erythrocyte transfusion. Paediatric fingertip replantation has similar survival rates, faster and better sensory nerve recovery as compared with adults despite a higher erythrocyte transfusion rate. Although technically demanding, paediatric fingertip replantation is recommended, whenever possible, because of the good outcomes achievable.Level of evidence: IV.
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Affiliation(s)
- Fethiye Damla Menkü Özdemir
- Department of Plastic, Aesthetic and Reconstructive Surgery, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Hakan Uzun
- Department of Plastic, Aesthetic and Reconstructive Surgery, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Erdi Özdemir
- Department of Orthopedics and Traumatology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Ali Emre Aksu
- Department of Plastic, Aesthetic and Reconstructive Surgery, Hacettepe University Faculty of Medicine, Ankara, Turkey
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Lemsanni M, Najeb Y, Chaouqui Y, Elkasseh M, Zoukal S. Fingertip injuries managed by a thenar flap: Follow-up and long-term outcomes of 32 cases. HAND SURGERY & REHABILITATION 2021; 40:484-490. [PMID: 33895423 DOI: 10.1016/j.hansur.2021.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 02/10/2021] [Accepted: 04/01/2021] [Indexed: 10/21/2022]
Abstract
While various techniques are used for the reconstruction of fingertip injuries, the main goals remain the same: preserve finger length, sensation, and function. The thenar flap is a well-described technique and simple procedure in fingertip amputations. This study aimed to evaluate the long-term functional and esthetic outcomes along with patient satisfaction of thenar flaps done for fingertip defects. Thenar flaps used in 32 patients operated between January 2010 and December 2016 were analyzed retrospectively to assess sensory recovery, range of motion, cold intolerance, pain relief, appearance, patient satisfaction, and QuickDASH score. All flaps survived, without adverse events. The flap was detached after 10-14 days (mean 12.5 days). The mean follow-up was 31 months (range, 20-45 months). According to Semmes-Weinstein monofilament test results, protective sensation was achieved in 25 patients (78%). The mean static 2-point discrimination was 6.1 mm. There were no functionally significant finger flexion contractures at the final follow-up. Complications such as pain, donor site morbidity and cold intolerance were not encountered. The thenar flap is an excellent technique for coverage of total or subtotal tissue loss of radial-side fingertips that is not accessible to local flaps. It provides good sensory function and appearance when fundamental technical principles (flap design, timing of division, and early mobilization) are respected.
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Affiliation(s)
- M Lemsanni
- Department of Orthopedic and Trauma Surgery, Ibn Tofail Hospital, Mohammed VI University Hospital Center, Abdelouahab Derraq Street, PB 40000 Marrakesh, Morocco.
| | - Y Najeb
- Department of Orthopedic and Trauma Surgery, Ibn Tofail Hospital, Mohammed VI University Hospital Center, Abdelouahab Derraq Street, PB 40000 Marrakesh, Morocco
| | - Y Chaouqui
- Department of Orthopedic and Trauma Surgery, Ibn Tofail Hospital, Mohammed VI University Hospital Center, Abdelouahab Derraq Street, PB 40000 Marrakesh, Morocco
| | - M Elkasseh
- Department of Orthopedic and Trauma Surgery, Ibn Tofail Hospital, Mohammed VI University Hospital Center, Abdelouahab Derraq Street, PB 40000 Marrakesh, Morocco
| | - S Zoukal
- Epidemiology Laboratory of the Faculty of Medicine and Pharmacy of Casablanca, Rue Tarik Ibnou Ziad, 20250 Casablanca, Morocco
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Abstract
Fingertip replantation is technically challenging, but in a motivated patient excellent aesthetic and functional outcomes can be achieved. Fingertip microanatomy by zone is described to facilitate the classification and treatment of these injuries. In this article, we outline our preferred techniques for fingertip replantation and review the current body of evidence surrounding indications, techniques, and outcomes while highlighting opportunities for future study.
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Affiliation(s)
- Amelia C Van Handel
- Division of Plastic & Reconstructive Surgery, Washington University in St. Louis, 660 South Euclid Avenue, Suite 1150, St Louis, MO 63110, USA
| | - Mitchell A Pet
- Division of Plastic & Reconstructive Surgery, Washington University in St. Louis, 660 South Euclid Avenue, Suite 1150, St Louis, MO 63110, USA.
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Chen Y, Wang ZM, Yao JH. Supermicroscopy and arterio-venolization for digit replantation in young children after traumatic amputation: Two case reports. World J Clin Cases 2020; 8:5394-5400. [PMID: 33269275 PMCID: PMC7674710 DOI: 10.12998/wjcc.v8.i21.5394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 09/23/2020] [Accepted: 10/01/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND To report the application of supermicroscopy combined with arterio-venolization without venous anastomosis for replantation of digits following traumatic amputation in young children.
CASE SUMMARY In March 2016, we treated two children aged 2 years and 7 years with traumatic digit amputation, no venous anastomosis, and bilateral digital inherent arteries on the palmar side. Supermicroscopy combined with an arteriovenous technique was adopted to improve the replantation surgery. Postoperative management involved auxiliary treatments such as anticoagulation, composure, anti-inflammatory drugs, and insulation. After treatment, the amputated fingers survived completely without major complications, with good recovery.
CONCLUSION Supermicroscopy combined with arterio-venolization is a safe and effective approach to treat traumatic digit amputation in young children without venous anastomosis.
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Affiliation(s)
- Yun Chen
- Department of Pediatric Orthopedics, The Third Affiliated Hospital of Southern Medical University, Guangzhou 510000, Guangdong Province, China
| | - Ze-Min Wang
- Department of Pediatric Orthopedics, Loudi Central Hospital, Loudi 417000, Hunan Province, China
| | - Jing-Hui Yao
- Department of Pediatric Orthopedics, The Third Affiliated Hospital of Southern Medical University, Guangzhou 510630, Guangdong Province, China
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Kim DH, Yang S, Seo KB, Kwak SH, Rhee SJ, Ahn TY, Lee SH. Serial stab incision venous drainage technique for simple artery-only fingertip replantation. J Orthop Surg (Hong Kong) 2020; 27:2309499019831480. [PMID: 30827170 DOI: 10.1177/2309499019831480] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
PURPOSE Fingertip replantation is a challenging and technically demanding procedure. A variety of venous drainage techniques have been attempted for successful fingertip replantation. We present a new venous drainage technique, known as serial multifocal incision for fingertip replantation. METHODS Between 2006 and 2014, we performed 94 fingertip replantations without vein anastomosis. Eighty of the patients were male, and 14 were female, with an overall mean age of 42 years (range: 8-67 years). All patients suffered amputations distal to the distal phalanx joint (Ishikawa subzone I, II, or III). We performed only artery anastomosis. To relieve venous congestion, we incised the fingertip 2-3 mm using a number 11 scalpel blade and allowed the vein to drain naturally. We made small serial incisions every 2-3 days for 1 week. RESULTS The overall success rate for this procedure was 90%, with 85 surviving digits. Two patients with partial necrosis and nine patients with complete loss needed a second operation. Two patients received blood transfusions with an average of 1.5 units, but both had an accompanying injury at another site. No one complained of nail deformity or wound infection. CONCLUSIONS Various external bleeding techniques have been reported to yield good results. The serial stab incision venous drainage technique is a modified fish-mouth external bleeding technique that overcomes the disadvantages of published methods. This technique is simple, allows for easy control of venous drainage, and reduces the need for blood transfusions compared to other venous drainage techniques that cause large amounts of bleeding. We propose a new method, the serial stab incision venous drainage technique, which is effective and associated with high rates of survival.
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Affiliation(s)
- Dong Hee Kim
- 1 Department of Orthopedic Surgery, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Republic of Korea
| | - Seongwook Yang
- 1 Department of Orthopedic Surgery, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Republic of Korea
| | - Kyu Bum Seo
- 2 Department of Orthopedic Surgery, College of Medicine, Jeju National University, Jeju, Republic of Korea
| | - Sang Ho Kwak
- 3 Department of Orthopaedic Surgery, Medical Research Institute, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea
| | - Seung Joon Rhee
- 4 Department of Orthopaedic Surgery, Medical Research Institute, Pusan National University Hospital, Pusan, South Korea
| | - Tae Young Ahn
- 4 Department of Orthopaedic Surgery, Medical Research Institute, Pusan National University Hospital, Pusan, South Korea
| | - Sang Hyun Lee
- 4 Department of Orthopaedic Surgery, Medical Research Institute, Pusan National University Hospital, Pusan, South Korea
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Kayalar M, Güntürk ÖB, Gürbüz Y, Toros T, Sügün TS, Ademoğlu Y. Survival and Comparison of External Bleeding Methods in Artery-Only Distal Finger Replantations. J Hand Surg Am 2020; 45:256.e1-256.e6. [PMID: 31421938 DOI: 10.1016/j.jhsa.2019.06.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Revised: 05/21/2019] [Accepted: 06/28/2019] [Indexed: 02/02/2023]
Abstract
PURPOSE If there are no veins available in a distal amputation, an artery-only replantation is performed, and an external bleeding method is commonly used. We conducted a survival analysis in a large series of artery-only replantations and compared 2 different external bleeding methods in artery-only distal replantations: nail matrix or hyponychial area bleeding and pulp skin area bleeding, which we have called the crater method. METHODS Two hundred twenty-eight artery-only distal finger replantations in 199 patients were included in the study. The replanted digits were divided into 2 groups according to the external bleeding methods. One group (n = 94; 41.2%) included the patients in whom the external bleeding was performed using a traditional nail bed incision and the second group (n = 134; 58.8%) included the patients in whom external bleeding was performed using the crater method. The finger survival rates and postoperative circulatory problems were examined. The impact of the injury mechanism, injury level, and external bleeding method on survival were evaluated. RESULTS Clinical findings indicating venous insufficiency were observed in 198 (86.8%) replanted fingers. One hundred eighty-two (79.8%) survived, and complete necrosis developed in 46 (20.2%). Viability was maintained in 84% of patients treated with the nail bed bleeding method and 76.9% of patients treated using the crater method. Clean-cut cases had the best results and subzone 3 cases had the worst results. CONCLUSIONS The artery-only replantation was associated with a 79.8% survival rate. The method of achieving venous outflow did not appear to have an impact on survival. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic IV.
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Affiliation(s)
| | - Özgün Barış Güntürk
- Hand Surgery Department, Gaziantep Dr. Ersin Arslan Education and Research Hospital, Gaziantep, Turkey.
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Thayer MK, Bellevue KD, Friedrich JB. Current concepts in hand and upper extremity amputations. CURRENT ORTHOPAEDIC PRACTICE 2018. [DOI: 10.1097/bco.0000000000000591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Zhu ZW, Zou XY, Huang YJ, Liu JH, Huang XJ, He B, Wang ZT. Evaluation of sensory function and recovery after replantation of fingertips at Zone I in children. Neural Regen Res 2017; 12:1911-1917. [PMID: 29239339 PMCID: PMC5745847 DOI: 10.4103/1673-5374.219053] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Sensory function is the most significant criterion when evaluating the prognosis of replanted fingers. Current clinical research has focused on surgical techniques and indications for finger replantation; however, few studies have focused on recovery of finger sensory function after replantation. This study retrospectively assessed data of eight patients who had undergone nine Zone I replantations of the fingertips in the First Affiliated Hospital of Sun Yat-sen University of China from July 2014 to January 2016. Variations in the extent of damage, with the residual vessels or nerves in some fingers being too short or even missing, prevented tension-free suture repair in some patients. Thus, repair of four of the nine fingertips included arteriovenous anastomosis, the remaining five undergoing arterial anastomosis during replantation of the amputated fingers. Three patients underwent nerve repair, whereas the remaining six cases did not. Fingertip replantations were successful in all eight patients. Compared with the patients without vascular anastomosis, no obvious atrophy was visible in the fingertips of patients who did undergo vascular anastomosis during replantation and their sensory function did recover. Fingertip replantation provides good sensory function and cosmetic outcomes when good artery and vein anastomoses have been created, even when digital nerves have not been repaired.
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Affiliation(s)
- Zhao-Wei Zhu
- Department of Plastic Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong Province; Department of Orthopedics and Microsurgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong Province, China
| | - Xiao-Yan Zou
- Department of Neurology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong Province, China
| | - Yong-Jun Huang
- Department of Orthopedics, Guangdong Second Provincial General Hospital, Guangzhou, Guangdong Province, China
| | - Jiang-Hui Liu
- Department of Emergency, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong Province, China
| | - Xi-Jun Huang
- Department of Orthopedics and Microsurgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong Province, China
| | - Bo He
- Department of Orthopedics and Microsurgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong Province, China
| | - Zeng-Tao Wang
- Department of Hand and Foot Surgery, Provincial Hospital Affiliated to Shandong University, Jinan, Shandong Province, China
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