Use of the metatarsal venous arch for replantation in the metacarpal region of the hand

Abstract

The use of vein grafts has increased the successful survival rate of replanted fingers or hands.? Utilizing vein grafts in replantation allows a reduction in tension between the anastomosed vessels. However, the disadvantage of this method is that, especially in the case of multiple arterial injuries such as amputation in the palm, it requires more operating time to establish multiple vessel anastomoses. In these cases a metatarsal venous arch graft obtained from the dorsum of the foot is an excellent alternative. The indication for this technique is replantation at the metacarpal level of the hand in which the superficial palmar arch is lost, and cannot be repaired without vein grafts (Fig. 1). After suturing the transected tendons, a dorsal venous arch of the right foot is obtained as a vein graft, with several communicating branches of the cutaneous veins (Fig. 2). The vein graft is then transferred to the arterial defects in the metacarpal region, and the distal end of the graft is anastomosed to the proximal end of the superficial palmar arch. The branches on the proximal portion of the vein graft are joined to the ends of the palmar metacarpal or digital arteries (Figs. 3 and 4). It is generally accepted that vein grafts from the forearm or the lower leg are essential for the successful reconstruction of long or short arterial defects in amputated hands or the fingers.? However, in the case of wide crush amputation especially at the metacarpal level it is very time-consuming to reconstruct the several