Mangled finger salvage using cross-finger revascularization

Song Chen,Yimin Chai,Yimin Chai,Liang Cheng,Liang Cheng,Gen Wen,Gen Wen

doi:10.1186/s13018-020-01621-w

Abstract

BackgroundMangled finger with impaired arteria digitalis communis remains to be a challenge for replantation surgery due to the limited amount of tissue to work with.MethodsOut of 554 hands with total finger amputations treated by replantation of finger/fingers from July 2012 to June 2018, there were 7 cases of damaged arteria digitalis communis, all of which were replanted by anastomosing distal adjacent radial/ulnar digital artery to distal end of ulnar/radial digital artery of amputation finger, and 2 veins were anastomosed for each finger. A skin pedicle was made by suturing both dorsal and palmar skin of adjacent fingers, and detachment was performed 4 weeks postoperatively.ResultsThe survival rate was 100%. Mean total active motion was 191.4° (ranging from 170 to 220°). Mean 2-point discrimination was 8 mm static (ranging from 6 to 11 mm), and mean grip strength was 35.3 kg (range, 29 to 40 kg).ConclusionsBased on our experience, cross-finger revascularization is an effective and safe alternative for mangled finger salvage when arteria digitalis communis is damaged, and good functional prognosis can be expected.

Highlights

Mangled finger with impaired arteria digitalis communis remains to be a challenge for replantation surgery due to the limited amount of tissue to work with
Many factors can affect the prognosis, but impaired arteria digitalis communis is a particular problem for finger replantation surgery
Seven of these cases were complicated with damaged arteria digitalis communis and were replanted by anastomosing distal adjacent radial/ulnar digital artery to distal end of ulnar/ radial digital artery of amputation finger

Summary

Introduction

Mangled finger with impaired arteria digitalis communis remains to be a challenge for replantation surgery due to the limited amount of tissue to work with. Over the ensuing four decades, many refinements and advances had been made in microsurgical techniques resulting in a success rate of 92–99% for digital replantation, but replantation surgery is still a challenge because the surgeon needs to perform the operation quickly while potentially be facing limited amount of tissue to work with [2, 3]. Most surgeons treat digital amputation with damaged arteria digitalis communis as a complication of replantation. Both the proximal and distal neurovascular bundles are extensively damaged, making it difficult to

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