Dorsal Digital Vein Research Articles

Application of modified arterial venalization in replantation of distally severed finger at nail root without venous anastomosis

Objective To introduce an improved method of reconstructing venous reflux in replantation of distally severed finger at nail root, and explore its clinical efficacy. Methods From January 2016 to September 2018, 12 patients with 13 distally severed fingers at nail root were replanted. There were no veins to anastomose the two severed ends. The proximal bilateral proper digital artery was anastomosed with the distal digital artery or two branches. The proximal digital artery was cut off and anastomosed with the proximal dorsal digital vein to establish venous reflux. Results In 13 replanted fingers, 1 finger had partial necrosis due to serious tissue contusion, and the other 12 fingers survived completely. No venous crisis occurred after operation. The postoperative follow-up time ranged from 3 to 9 months with an average of 6.0 months. The skin texture of replanted finger was good, the nail grew well, and the sensation recovered to over S3. The patient was satisfied with the appearance and function. Conclusion The modified arterial venalization can effectively solve the venous reflux problem in venous deficiency and improve the survival rate of replantation of distally severed finger at nail root. It is an effective way to reconstruct venous reflux in the absence of severed veins. Key words: Replantation; Treatment outcome; Arterial venalization; Venous reflux

Effects of free mini-flap on tibial side of third toe on repairing skin and soft tissue defect of finger pulp at the end of finger

Objective: To investigate the effects of free mini-flap on tibial side of third toe on repairing skin and soft tissue defect of finger pulp at the end of finger. Methods: From August 2013 to May 2017, 18 patients with skin and soft tissue defect of finger pulp at the end of finger were admitted to our unit, with 12 men and 6 women aged 16 to 54 years. As the skin and soft tissue defect sites, there were 3 cases of thumb, 8 cases of index finger, 4 cases of middle finger, and 3 cases of ring finger. The area of defects ranged from 2.0 cm×1.4 cm to 3.5 cm×2.4 cm. Free mini-flaps on tibial side of third toes were designed according to area and shape of defects, and the length and width of flaps were 0.1 to 0.2 cm longer than the length and width of the defects, respectively. The area of flaps ranged from 2.1 cm×1.5 cm to 3.7 cm×2.6 cm. The end-to-end anastomosis of subcutaneous veins of flaps and superficial veins of the finger-palm side or superficial dorsal digital vein, the end-to-end tension-free anastomosis of the base metatarsal arteries on tibial side of third toe and proper digital arteries of recipient finger were performed. Besides, anastomosis of base metatarsal nerve on tibial side of third toe and proper digital nerve of recipient finger was performed. The donor sites on feet were sutured directly or repaired with full-thickness skin grafts on medial upper leg of the same side. The survival of flaps after operation and the follow-up of patients were observed. Results: All flaps survived well, with good blood supply. Among the 18 patients, 2 patients lost to follow-up, and 16 patients were followed up for 4 to 36 months. The shape and texture of flaps were good. After reconstruction, finger pulps at the end of finger were plump, with fingerprint. Function of the finger restored well, and the two-point discriminatory distances of flaps were 5 to 10 mm. The donor sites on feet of 14 patients healed after the operation, the other 2 patients had necrosis on edge and central area of skin grafts, and the necrotic area healed after dressing change. The skin graft areas on feet were wear-resistant, with slight damage to donor sites and did not influence shoes wearing and walking. Besides, patients did not feel uncomfortable. Conclusions: Skin and soft tissue defects of finger pulp at the end of finger repaired by free mini-flaps on tibial side of third toe are with good shape and slight damage to donor sites, and the operation is simple. It is worthy of popularization and application in clinic.

Anastomosis to the common and proper digital vessels in free flap soft tissue reconstruction of the hand.

This study seeks to demonstrate the safety of anastomosing free flaps to the common or proper digital artery, and to the volar or dorsal digital vein in soft tissue reconstruction of the hand; as well, as to discuss the advantages of this technique. Retrospective review of all patients who underwent free flap reconstruction of the hand in two institutions over a period of 5 years. A total of 29 free flaps (9 great toe pulp, 7 anterolateral thigh, 6 second toe pulp, 4 radial artery perforator, 2 partial medial rectus, 1 lateral arm) in 28 patients met our inclusion criteria. All recipient vessels were the proper or common digital artery and the volar or dorsal digital vein. There was one case of venous congestion that resolved with leeching. There was no partial or total loss of any of the flaps. Anastomosing soft tissue free flaps to the common or proper digital artery, and the volar or dorsal digital vein is a safe and effective approach with numerous advantages that should be considered in the reconstruction of soft tissue defects of the hand. © 2016 Wiley Periodicals, Inc. Microsurgery, 38:21-25, 2018.

Back to basics: iatrogenic intravenous cannula embolus

We present a case of distal venous embolisation of a peripheral intravenous cannula tip that had lost its structural integrity through repeated failed attempts of insertion of the same cannula, contrary to protocols for intravenous access. Radiological imaging confirmed the presence of a foreign body in the middle finger and the patient was brought to theatre. A 2.2cm long catheter tube was removed via a venotomy from the dorsal digital vein.

Distally Based Dorsal Digital Fasciocutaneous Flap for the Repair of Digital Terminal Amputation Defects

The preferred plastic surgery regimen for distal digital segment wounds remains unknown, although multiple options are available for the repair. The purpose of this investigation is to study its anatomic rationale and clinical outcomes, in addition to the role of dorsal digital veins in digital reconstruction. Patients (n = 765) suffering from digital terminal segment traumatic wounds (823 digits) were identified and reviewed in a retrospective manner. The wounds were repaired using distally based dorsal digital fasciocutaneous flaps with venoneuroadipofascial pedicles. Skin flaps survived in 818 digits (99.4%), whereas 5 flaps (0.6%) became partially necrotic. Postoperative follow-up data were available from 521 patients involving 559 digits, for an average duration of 10 months (range, 4-36 months). The wider pedicled fascial flap (1.0-1.5 cm) was significantly associated with a decreased occurrence of blebs, whereas the first few patients with pedicled fascial flaps 0.5 to 1.0 cm wide exhibited more frequent occurrence of blebs and flap contractures. The flaps retracted in size within the first 2 to 3 months at the rate of 10% compared with the intraoperative outlined size. The skin flaps became mildly pigmented within the first postoperative month, and at 6 months the flaps turned brighter in color, almost approximating the color of the normal digits. At 12 months, both the texture and appearance of the flaps were acceptable. The donor sites healed without any scar contracture. The digital terminals appeared grossly normal with acceptable digital function. Without any neural reconstruction, skin flap sensation was rated as S2 to S3+, whereas with neural reconstruction the 2-point discrimination sensitivity measured 4 to 9 mm. The use of a distally based dorsal digital fasciocutaneous flap with venoneuroadipofascial pedicle was a simple, safe, and less invasive regimen for repairing digital terminal segment wounds.

Composite flap transfer from the foot for treatment of multi-finger complex soft tissue defects

Objective To introduce the clinical application of composite flap transfer from the foot for treatment of multi-finger complex soft tissue defects. Methods This method was applied to treat 7 cases and 19 fingers. All the cases involved complex dorsal soft tissue defect of 2 to 4 fingers with extensor tendons missing and phalanx or interphalangeal joint exposed. The combined soft tissue defect area was 5.0cm×1.5cm to 9.0 cm× 2.5 cm. The flaps were designed along the axis extending from the fibular and plantar margin of the great toe to the interspace between the first and second metatarsal bones. The flap was slightly larger than the dorsal finger defect combined and the shape of the flap was the same as the combined defect. The greater saphenous vein, dorsal digital veins and dorsal metatarsal or plantar metatarsal artery and nerves were included in the flap. They were sutured with dorsal digital veins, digital artery and nerves, respectively. Extensor digitorum brevis tendons and extensor digitorum longus tendons were included in the flap to reconstruct the missing tendons. Results All the flaps survived with good texture and good appearance. Two-point discrimination recovered 6 to 8 mm. Finger extension function was restored, and active finger flexion and extension recovered satisfactorily. The donor feet were with slight scar, good appearance and normal function. Conclusion Combined dorsalis pedis,toe web and great toe fibular flap including extensor digitorum brevis and extensor digitorum longus tendon is a good option to treat multi-finger dorsal complex defects. Key words: Surgical flaps; Finger injuries; Tendon injuries; Transplantation

Free medial plantar artery perforator flap for finger pulp reconstruction: Report of a series of 10 cases

Treatment of composite tissue loss in the finger pulp is often difficult. The purpose of this report is to present our experience on using medial plantar artery perforator flap for repair of finger pulp defects and to restore fingertip sensation after traumatic injury. The free medial plantar artery perforator (MPAP) flaps were performed for digital pulp reconstruction in ten patients (eight fingertips and two thumbtips) between June, 2006 and December, 2007. This flap blood supply was perforator vessel of medial plantar artery, which was through the intermuscular septum between the abductor hallucis muscle and the flexor digitorum muscle. The recipient vessels were digital artery and dorsal digital vein. The flap was not reinnervated during transfer procedures. The donor sites were closed primarily in all cases. Flap size ranged from 15 x 25 mm to 60 x 20 mm. All flaps were survival. Partial loss occurred in one flap, due to venous congestion caused by excessive stitch tension. The donor sites healed unevenfully in eight cases, but mild wound dehiscence occurred in two cases. The follow-ups ranged from 6 to 29 months with the mean of 18.1 months. The mean of s-2PD and m-2PD were 8.8 mm and 6.8 mm at patients' last visits, respectively. MPAP flaps are good in terms of general morbidity, cosmetic results, and durability. This flap is a valuable alternative method of repairing the glabrous finger pulp and tip defects.

Micro magnetic resonance angiography of the finger in systemic sclerosis

To characterize vascular lesions in SSc disease with high-resolution magnetic resonance angiography (Micro-MRA) of the finger. Eight SSc subjects and eight age- and sex-matched healthy controls were recruited for this study. Among the SSc subjects, the mean +/- s.d. age was 54.5 +/- 4.9 yrs, and the mean +/- s.d. duration of disease was 8.3 +/- 8.4 yrs. The numbers of SSc subjects that had telangiectasia, calcinosis and impaired finger flexion were 3, 2 and 3, respectively. The 2D time-of-flight micro-MRA was performed on a 3T clinical MRI scanner using a custom-designed finger coil with an in-plane resolution of 0.16 x 0.21 mm(2) and slice thickness of 1.2 mm. The data for the proper palmar digital artery lumen area, the number of visible dorsal digital veins and a semi-quantitative vascular score, which evaluates the overall integrity of digital vessels, were independently evaluated by two experienced reviewers who were blinded to the status of the subject. Micro-MRA detected significant differences in the digital vasculature between SSc subjects and healthy volunteers. The SSc subjects had a significantly decreased digital artery lumen area (0.13 +/- 0.06 vs 0.53 +/- 0.26 mm(2), P < 0.001), a reduced number of digital veins (0.63 +/- 1.06 vs 3.13 +/- 0.99, P = 0.001) and a lowered overall vascular score (1.75 +/- 1.04 vs 3.5 +/- 0.53, P = 0.001). The study also found that both the digital artery lumen area (Pearson's; r = -0.72, P = 0.044) and vascular scores (Spearman's; rho = -0.75, P = 0.047) of the SSc subjects were inversely correlated with the duration of the disease. Micro-MRA can be used to identify and quantitatively characterize the vascular disease in SSc fingers. The parameters derived from micro-MRA could potentially be used as prospective biomarkers for clinical evaluation.

Application of the fibular flap of the second toe in treatment of hand cutaneous deficiency

目的 探讨第2足趾腓侧皮瓣移植的应用解剖及临床应用的适应证、手术方法和优缺点等.方法新鲜成人尸体足左、右各10只,经灌注、解剖、测量,了解皮瓣的血供范围和相关血管、神经的外径.临床应用17例修复手部皮肤缺损,了解皮瓣的成活及功能恢复情况.结果灌注剂可达整个第2足趾及相邻趾蹼,测得第2足趾跖趾关节处腓侧固有动脉、趾背静脉分别为(1.0±0.2)mm、(0.9±0.2)mm;临床应用17例移植皮瓣全部成活,手、足部均无感染.经半年以上随访,被修复手指外观、颜色接近正常,供足无疼痛和植皮破溃现象发生.结论第2足趾腓侧皮瓣血供可靠,口径适于吻合,质地好,适于手指皮肤确实的修复。

Vascular anatomic variations in second toe transfers

To devise a new classification of vascular variations in second toe transfer we analyzed the anatomic details of the first dorsal metatarsal artery in 304 cases of second toe transplantation and the venous structure in 200 cases. According to location, the arterial vascularity was classified as superficial (18% of cases), intramuscular (54%), inframuscular (23%), and absent (5%). According to diameter, it was classified into large (16%), medium (64%), and small (20%). Based on branching pattern, the artery was classified into ramifying type (88%), main trunk (4%), and fine branch type (8%). The venous drainage of the second toe was categorized as greater saphenous vein main trunk type, greater saphenous vein fine branch type, dorsal digital vein main trunk type, and dorsal digital vein fine branch type. Variations of the first dorsal metatarsal artery are common. Classification should be done according to its location, diameter, and branching pattern at the toe web. Regardless of location, big vessels entering the second toe are the most important attribute for successful outcome.

A neurovascular island flap including a vein for the treatment of an acquired ring constriction

We present a case of an acquired constriction band caused by a tight ring on the left middle finger of a 45-year-old man. Most of the constriction band was excised and the resulting defect reconstructed with a neurovascular island flap, including a dorsal digital vein, from the adjacent ring finger. The distal end of the artery and the nerve in the flap were anastomosed and coapted to the digital artery and nerve, respectively, at the distal edge of the defect after excision of the band. The vein in the flap was anastomosed to a dorsal vein at both the distal and proximal edges of the flap as a vascularised interpositional vein graft. Four months later, the remaining constriction band was excised and the defect closed by an advancement flap. Swelling of the finger decreased and sensation improved.

A distally based island first dorsal metatarsal artery flap for the coverage of a distal plantar defect

An intractable plantar ulcer of the great toe was successfully covered with a distally based island first dorsal metatarsal artery flap. Common dorsal digital veins served as venous drainage for the flap. The results show that this flap can be used as a reliable alternative to conventional techniques to repair a distal foot defect.

A macroscopic study of the vascular system of the bovine hind limb claw

The vascular organisation of the hind limb claws from clinically normal cattle was studied using plastic corrosion casts. The proper digital artery ran dorsodistally within the interdigital space and gave off a bulbar branch to the bulb, a plantar branch to the axial aspect of the wall and sole, and a coronary artery to the coronary margin and proximal wall. The artery entered the distal phalanx at the axial foramen, coursed through the nutrient canal as the terminal arch, and emerged at the abaxial foramen to anastomose with branches of the bulbar artery. During its interosseous course, the terminal branch gave off 6-8 primary branches which provided the arterial supply to the coronary margin, axial and abaxial wall, white zone and sole. The dorsal proper digital vein and axial and abaxial proper plantar digital veins drained all venous blood from the claw. Each of these large veins arose from numerous smaller veins which joined to form the venous networks of the coronary margin, wall, sole and bulb. A large arched vein passed through the coronary cushion and formed a connection between the superficial coronary venous plexus and the intra-osseous plexus of the distal phalanx. The axial and abaxial proper plantar digital veins were connected by a vessel through the bulbar cushion. At the same level, the axial proper plantar digital veins of the lateral and medial claw were connected to each other by a large vessel through the interdigital space, situated just proximal to the distal interdigital ligaments. This resulted in the presence of a complete distal venous arch along the plantar aspects of both claws. The parietal collecting veins drained most of the venous blood from the sole, white zone and wall, and connected directly to the venous plexuses of the coronary margin and bulb. Valves occurred commonly in medium and larger calibre veins throughout the claw.

Studies on Intravenous Regional Analgesia of the Hind Limb in the Bovine

Twenty-five buffalo calves (age: 14 +/- 1.9 months; body weight: 102 +/- 9.4 kg) were subjected to intravenous regional analgesia (IRA) of the hind limb with 2% lignocaine HCl (4 mg/kg b.w.), infused through the dorsal digital vein. In control animals 15 ml of normal saline was infused. The effect of tourniquet release after 35 (8 calves) and 65 min (7 calves) on EEG, ECG, arterial and venous pressures, blood gases and pH, respiration and temperature were studied. A detectable concentration of lignocaine occurred before the release of tourniquet. The lignocaine concentration recorded in the systemic circulation did not produce any significant nervous or cardiovascular changes before or after release of tourniquet. Transient EEG and ECG changes were seen in six (tourniquet release after 35 min) and three (tourniquet release after 65 min) IRA animals, respectively. No significant changes were seen in heart rate, respiratory rate and rectal temperature, systolic, diastolic, mean arterial and central venous pressures. Arterial blood pH, PCO2 and HCO3- concentration showed no significant differences. Animals receiving IRA did not show hypoxaemia typical to postural changes.

An Experimental Study of the Venous Flap: Investigation of the Recipient Vein

In previous studies using rabbit ears, total venous perfusion flaps (TVPF) were used that did not contain in the experimental model any chosen arteries truly representative of clinical venous flaps. We discovered that the TVPF could survive even under conditions of poor blood circulation. In the present study, conditions of the recipient veins were investigated using flow-through veins in TVPFs of rabbit ears and human dorsal digital veins. The research suggested that conditions for TVPF survival are a high density of the venous network in the flap and the presence of venous oscillation, high oxygen tension, and effective blood flow in the recipient vein.

Cross circulation at the small blood vessel level in the dog paw.

Small vessel responses to maximal sympathetic stimulation have been studied by establishing a cross circulation, at the small blood vessel level, between the two hind legs of the dog. This technique permitted the differentiation between vascular responses occurring upstream and downstream from the level of the cross circulation. Sciatic nerve stimulation stopped flow in both upstream and downstream arterial segments. Lumbar sympathetic trunk stimulation (which did not include all nerves supplying the digital vasculature) stopped flow in the upstream arteries, but allowed a restricted flow to continue in the downstream segments. Both lumber and sciatic nerve stimulation produced intense constriction of dorsal metatarsal and digital veins. Establishment of a cross circulation at either the dorsal metatarsal or dorsal digital vein level proved that in unstimulated vessels a retrograde flow from small vein to small artery was possible. During maximal sympathetic stimulation, constrictive closure of small veins prevented flow from occurring either upstream or downstream in metatarsal and digital veins until perfusion pressures were increased to approximately 100 mm Hg. Thus, constrictive closure of the venules protected the capillaries from the high small vein pressures developed during maximal sympathetic stimulation.