Clinical evaluation and hemodynamics analysis of fingertip replantation with anastomosis of digital artery terminal branch only

Abstract

Objective To investigate the hemodynamics of collateral flow in fingertip replantation with anastomosis of digital artery terminal branch only.Methods From September 2009 to March 2013,replantation of 58 severed fingertips was carried out.Intraoperative only one terminal branch of the digital artery was anastomosed.Care was taken to preserve the integrity of the digital artery arch and the branches proximal to the anastomotic site.Neither nail bed bleeding nor small incision bleeding was done postoperatively.Results Among the 58 replants,55 fingertips survived while 3 were lost due to necrosis,the survival rate being 94.8％.Postoperative follow-up period ranged from 3 to 12 months (average,7.8 months).The survived fingertips were full,with normal growing nails and good appearances.Static two-point discrimination was 3 to 7 mm.Conclusion High survival rate can be achieved in fingertip replantation with anastomosis of one digital artery terminal branch only.Preserving the arterial arch provides sufficient collateral flow.Analysis of the collateral flow in the replanted finger using Bernoulli's Law (P + 1/2 ρg2 + ρgh =constant) of hemodynamics shows that collateral branches proximal to the anastomosis can provide collateral drainage.This is the main mechanism for the survival of replanted fingertips when only one terminal branch of the digital artery is anastomosed. Key words: Fourier analysis; Replantation; Collateral; Shunt