Modified venous grafting to replant an amputated thumb with obstinate arteriospasm / 中华创伤骨科杂志

ABSTRACT

Objective To evaluate the therapeutic effects of bridging the proper digital artery and the radial artery with a vein graft in replantation of an amputated thumb with obstinate arteriospasm.Methods From June 2011 to May 2017,9 patients received replantation of an amputated thumb at Department of Hand Surgery,The Second Hospital of Tangshan.They were all male,aged from 21 to 55 years (average,39.2 years).Two right thumbs were involved in 2 cases and 7 left thumbs in 7 cases.During replantation,obstinate arteriospasm which could not be alleviated occurred of their bilateral proper digital arteries.A free forearm superficial vein graft was used to bridge the distal end of ulnar proper digital artery of thumb and the radial artery in tabatiere anatomique to establish blood supply by end-to-end or end-to-side anastomosis.At final follow-up,the outcomes were assessed by the tentative criteria set by The Hand Surgery Society of Chinese Medical Association.Results All the 9 replanted thumbs survived with primary wound healing.They were followed up for 6 to 12 months (mean,7.9 months).All the patients were satisfied with the appearance and function of the replanted thumb except that mild atrophy was observed in 2 digits with preoperative rotatory avulsion.According to the tentative criteria set by The Hand Surgery Society of Chinese Medical Association at final follow-up,the outcomes were rated as excellent in 7 cases and as good in 2.The pulp two-point discrimination was between 3 and 8 mm,with an average of 5.3 mm.Conclusions An amputated thumb with obstinate arteriospasm can be replanted by bridging the ulnar proper digital artery of thumb and the deep branch of radial artery using a vein graft to establish adequate blood supply to the replanted thumb,leading to satisfactory efficacy.As the technique is easy,it is worthy of popularization.