Anatomical Study of the Fingertip Artery in Tamai Zone I: Clinical Significance in Fingertip Replantation

Anatomical Study of the Fingertip Artery in Tamai Zone I: Clinical Significance in Fingertip Replantation

Reply to a Letter to the Editor: Anatomical Study of the Fingertip Artery in Tamai Zone I: Clinical Significance in Fingertip Replantation

I read with great interest the article by Yong SN, Young JJ, In-Beom K, et al[1] entitled “Anatomical Study of the Fingertip Artery in Tamai Zone I: Clinical Significance in Fingertip Replantation.” First of all, I wish to congratulate the authors on their cadaveric study of the arterial pattern of the fingertip. It is the first report of the arterial anatomic description in the nail part in the literature.

In my 20 years of clinical experiences about the distal phalanx replantation (>300 digits), I am not quite agreeable to one of the conclusions of the authors.

The reasons are as follows:

1. The articles as the authors mentioned did not really omit the importance of venous repair, because the survival rate is only around 83% in Tamai I replantation without venous repair.[2] Moreover, the use of arteriovenous anastomosis for the replantation of the distal fingers indicated the maintenance of the venous return by Koshima et al[3] also cannot be overlooked.

2. The authors presumed that bone marrow is the root of venous drainage. They pointed out two cases report of free vascularized fibular flap. I have different opinion on that. The mechanism of the vascularized bone transfer without vein repair is not the same as the distal replantation, because we usually do not fix the bone in Tamai I replantation. How would the venous return to the proximal part without bony fixation? Through what mechanism of these distal small tissues without venous drainage is still not well understood. It probably drained by the subcutaneous tissue and that is why the loosely skin closure is one of the important points in the distal replantation. An ambulatory case of hemi distal replantation without bony fixation or vein repair is presented ([Fig. 1]).

Fig. 1 (A, B) Preoperative view, (C) immediate postoperatively, and (D) 1 month postoperatively.

• References

• 1 Nam YS, Jun YJ, Kim IB, Cho SH, Han HH. Anatomical study of the fingertip artery in Tamai zone I: clinical significance in fingertip replantation. J Reconstr Microsurg 2017; 33 (01) 45-48
• 2 Sebastin SJ, Chung KC. A systematic review of the outcomes of replantation of distal digital amputation. Plast Reconstr Surg 2011; 128 (03) 723-737
• 3 Koshima I, Soeda S, Moriguchi T, Higaki H, Miyakawa S, Yamasaki M. The use of arteriovenous anastomosis for replantation of the distal phalanx of the fingers. Plast Reconstr Surg 1992; 89 (04) 710-714