Reverse Distal Transverse Palmar Arch in Distal Digital Replantation

PURPOSE: Refinements in microsurgery have made distal finger replantation an established technique with high success rates and good functional and aesthetic outcomes. However, it still represents a technically demanding procedure due to the small vessel caliber and frequent lack of vessel length, requiring the use of interpositional venous grafts in some instances. The purpose of this study is to provide a technical description and the results of a new technique for arterial anastomosis in fingertip replantation, whereby the need for venous grafts is eliminated.

METHODS: At the level of the nail base, the ulnar and radial digital arteries anastomose, forming the distal transverse palmar arch. By ligating one side of the arch, we can mobilize it and turn it distally for anastomosis in the distal stump, or proximally for arteriovenous shunting. Applying this technique, eleven cases (6 males and 5 females; age range, 18–54 years) of distal digital replantation were performed between January 2011 and May 2016. This technique was used for arterial anastomosis in ten cases and arteriovenous shunting for venous drainage in one case. A retrospective case review was conducted. The technical description and clinical outcome evaluations are presented.

RESULTS: Ten of the eleven replanted digits survived, corresponding to an overall success rate of 91%. One replant failed due to venous insufficiency. Blood transfusions were not required for any of the patients. Ten cases remained in hospital and one case was managed on an outpatient basis. Follow-up (range, 1.5 to 5 months) revealed near-normal range of motion (30–70 degrees) of the distal interphalangeal joint and good aesthetic results. All of the replanted digits developed protective sensation. The average length of hospital admission was five days. All patients were satisfied with the results and were able to return to their previous work.

CONCLUSION: The use of the reverse digital arterial arch is a novel and reliable technique in distal digital replantation when an increase in vessel length is required, allowing for a tension-free vessel repair without the need for vein grafts.