Successful Replantation of Tamai Zone I Amputation with Delayed Vein Repair

Zusammenfassung

Die Rekonstruktion digitaler Venen ist eine der schwierigsten Phasen der Endgliedreplantation. Distal lokalisierte digitale Venen haben ein kleines Gefäßkaliber und kollabierte Lumina, so dass sie nur schwer zu identifizieren und zu versorgen sind. Digitale Venen sind gelegentlich auch in den ersten Minuten nach der arteriellen Anastomose nicht erkennbar. In dieser Situation kann der Patient einige Stunden nach der Revaskularisierung erneut in den Operationssaal gebracht werden, um die dann erweiterten Venen sekundär zu rekonstruieren. Die verzögerte Rekonstruktion digitaler Venen ist eine zuverlässige und alternative Methode zur Replantation ohne Venennaht. In diesem Bericht wird eine erfolgreiche Replantation mit verzögerter Rekonstruktion digitaler Venen in der Tamai Zone I vorgestellt.

Abstract

Digital vein repair is one of the most challenging phases of distal phalanx replantation. Digital veins at very distal levels have a small vessel caliber and collapsed lumens, which makes them hard to identify and handle. Digital veins may not be visible immediately after arterial anastomosis. In this scenario, the patient can be taken to the operative room several hours after revascularization to visualize dilated and expanded veins for late digital vein repair. Late digital vein repair is a reliable and alternative method to artery only replantation. In this report, a successful replantation with late digital vein repair in Tamai Zone I is presented

Schlüsselwörter

Mikrochirurgie - Venenanastomose - Fingerendgliedreplantation

Key words

Microsurgery - vein repair - distal phalanx replantation

Publication History

Received: 16 May 2020

Accepted: 17 September 2020

Article published online:
21 January 2021

• References

• 1 Lee BI, Chung HY, Kim WK. et al. The effects of the number and ratio of repaired arteries and veins on the survival rate in digital replantation. Ann Plast Surg 2000; 44: 288-294
• 2 Scheker LR, Becker GW. Distal Finger Replantation. J Hand Surg Am 2011; 36: 521-528
• 3 Gordon L, Leitner DW, Bunke HJ. et al. Partial nail plate removal after digital replantation as an alternative method of venous drainage. J Hand Surg Am 1985; 10: 360-364
• 4 Arami A, Gurevitz S, Palti R. et al. The Use of Medicinal Leeches for the Treatment of Venous Congestion in Replanted or Revascularized Digits. J Hand Surg Am 2018; 43: 949.e1-e5
• 5 Etöz A, Karaca K, Ozgenel Y. et al. Milking technique for reimplanted digits with insufficient venous drainage. Tech Hand Up Extrem Surg 2005; 9: 122-123
• 6 Akyürek M, Safak T, Keçik A. Fingertip replantation at or distal to the nailbed: use of the technique of artery-only anastomosis. Ann Plast Surg 2001; 46: 605-612
• 7 Lineaweaver WC, Hill MK, Buncke GM. et al. Aeromonas hydrophila infections following use of medicinal leeches in replantation and flap surgery. Ann Plast Surg 1992; 29: 238-244
• 8 Koshima I, Soeda S, Moriguchi T. et al. The use of arteriovenous anastomosis for replantation of the distal phalanx of the fingers. Plast Reconstr Surg 1992; 89: 710
• 9 Zhang X, Wen S, Wang B. Reconstruction of circulation in the fingertip without vein repair in zone I replantation. J Hand Surg Am 2008; 33: 1597-1601
• 10 Mihara M, Nakanishi M, Nakashima M. et al. Distal phalanx replantation using the delayed venous method: a high success rate in 21 cases without specialised technique. J Plast Reconstr Aesthet Surg 2008; 61: 88-93
• 11 Wu F, Shen X, Eberlin RK. et al. The use of arteriovenous anastomosis for venous drainage during Tamai zone I fingertip replantation/Injury, Int. J Care Injured 2018; 49: 1113-1118
• 12 Koshima I. Successful delayed venous drainage in 16 consecutive distal phalangeal replantations. Plast Reconstr Surg 2005; 115: 149-154
• 13 Morrison WA, McCombe D. Digital replantation. Hand Clin 2007; 23: 1-12
• 14 Kabakas F. Dorsal Approach for Vascular Repairs in Distal Finger Replantations. Microsurgery 2016; 36: 628-636
• 15 Smith DO, Oura C, Kimura C. et al. The distal venous anatomy of the finger. J Hand Surg Am 1991; 16: 303-307
• 16 Sebastin SJ, Chung KC. A systematic review of the outcomes of replantation of distal digital amputation. Plast Reconstr Surg 2011; 128: 723-737
• 17 Klein-Weigel P, Pavelka M, Dabernig J. et al. Macro- and microcirculatory assessment of cold sensitivity after traumatic finger amputation and microsurgical replantation. Arch Orthop Trauma Surg 2007; 127: 355-360
• 18 Schwabegger AH, Hussl H, Ninković MM. et al. Replantationen im Kindes- und Jugendalter. Langzeitergebnisse. Unfallchirurg 1997; 100: 652-657