Non-microsurgical replantation (composite graft with palmar pocketing) – a case report of successful reintegration of distal finger amputation

Microvascular replantation in not always feasible for distal finger amputations. Our work presents a case of 23-year-old woman who suffered an amputation of index finger at the level of nail base. She was disqualified from microvascular replantation, however, the cooperation with Replantation Service resulted in an uncommon method of treatment, which resulted in excellent functional and aesthetic outcome. Composite grafting for fingertip amputations is a unique procedure which enables preserving original tissue with its function. We consider composite grafting to be a valuable adjunct to the wide range of methods for treating distal finger amputiations.

A Unique Case of Replantation of Previously Replanted Fingers

Replantation of digital amputations is now the accepted standard of care. However, rarely will a replantation surgeon be presented with amputated fingers which have been previously replanted. In our literature search, we could find only one publication where a replanted thumb suffered amputation and was successfully replanted again. We report the technical challenges and the outcome of replanting two fingers which suffered amputation 40 months after the initial replantation and were successfully replanted again. Replantation was critical since the amputated fingers were the only two complete fingers in that hand which had initially suffered a four-finger amputation. The second-time replantation of previously replanted fingers is reported to allay the concern of the reconstructive surgeon when faced with this unique situation of “repeat amputation of the replanted finger.” Second-time replantation is feasible and is associated with high-patient satisfaction. Replantation must be attempted especially in the event of multiple digit amputations.

Examination of the Dorsal Finger Vein Anatomy Using a Vein Visualization Device

Background: The vein anatomy of the dorsal finger is often difficult to identify suitable veins for anastomosis when treating digital amputations, but it has not been well studied to date. The aim of our study was to determine the vein anatomy of the dorsal finger using a vein visualization device. Methods: The study sample consisted of 20 volunteers (11 men and 9 women; 148 fingers and 37 thumbs). The number and location of veins, the distance from the finger midline to the most central vein, and the distance from the central vein to the adjacent vein were examined using a vein visualization device, Stat Vein®, at the eponychial level, distal interphalangeal (DIP) joints, and proximal interphalangeal joints. Results: In the finger, the distance from the nail lunula edge to the vein at the eponychial level was about 5 mm and that from the central vein to the adjacent vein at the DIP joints was about 8 mm. In the thumb, the distance from the nail lunula margin to the vein at the eponychial level was about 5 mm and that from the central vein to the adjacent vein at the interphalangeal joints was about 6 mm. Conclusions: Treatment of DIP joint-level finger amputation requires identification of the central vein at first and then the site about 8 mm away from the central vein. In the treatment of eponychial-level finger amputation, the vein is found about 5 mm away from the nail lunula edge.