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Chir Main. 2015 Oct;34(5):240-4. doi: 10.1016/j.main.2015.08.003. Epub 2015 Sep 26.

Replantation by palmar arteriovenous anastomosis in complex finger amputations.

Author information

1
Division of Plastic Surgery and Hand Surgery, University Hospital of Zurich, Raemistrasse 100, 8091 Zurich, Switzerland.
2
Division of Plastic Surgery and Hand Surgery, University Hospital of Zurich, Raemistrasse 100, 8091 Zurich, Switzerland. Electronic address: thomas.giesen@usz.ch.

Abstract

Digital replantation is a well-established and increasingly common procedure in specialized hand surgery units worldwide. Replantation after complex trauma is often challenging due to severely injured, small-diameter vessels, especially at the distal level. Digit salvage by arteriovenous anastomosis has been inadequately described in the literature for such cases. The objective of this study was to evaluate the outcomes and complications of arteriovenous digital replantation in complex amputations. We reviewed five cases of digital replantation using a single palmar afferent arteriovenous anastomosis and drainage via a dorsal vein. The postoperative protocol followed our standard replantation protocol. All digits survived with no revision procedures. No major complications were observed. One digit developed partial epidermolysis and one thumb developed marginal skin necrosis, both treated conservatively. The color of the replanted digits was not a reliable monitoring parameter but capillary refill was consistently visible. Microangiography performed four months after surgery demonstrated good digit perfusion. Our results support palmar arteriovenous anastomosis as a reliable alternative in digital replantation if distal arteries are unavailable for anastomosis. The results also suggest that this digit salvage procedure can be carried out at a more proximal level than previously reported.

KEYWORDS:

Amputation digitale; Anastomose artério-veineuse; Arteriovenous anastomosis; Finger amputation

PMID:
26404796
DOI:
10.1016/j.main.2015.08.003
[Indexed for MEDLINE]

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