Nonarterialized Venous Replantation of Part of Amputated Thumb—A Case Report and Review of the Literature

Abstract

Since the first successful replantation of a human thumb reported by Komatsu and Tamai in 1968, thousands of severed digits and body parts have been successfully salvaged. Restoration of anatomic form and function are the goals of replantation after traumatic tissue amputation. Regardless of anatomic location, methods include microsurgical replantation and nonmicrosurgical replantation, such as composite graft techniques. Numerous techniques to maximize tissue survival after revascularization have been described, including "pocket procedures" to salvage composite grafts, interposition vein grafts, and medicinal leeches to name a few. Artery-to-venous anastomoses have been performed with successful "arterialization" of the distal venous system in fingertip replantation. Although there is documented survival of free venous cutaneous flaps, to our knowledge this is the first report of a replanted composite body part (bone, tendon, soft tissues, and skin) utilizing exclusively multiple, microvascular, nonarterialized venous-venous anastomoses. We present a patient with an isolated band saw fillet amputation to the back of the thumb at the metacarpal-phalangeal joint region, resulting in a composite graft composed of bone, tendon, soft tissue, and skin. The hand wound provided no viable regional arterial inflow source, but there were multiple good caliber superficial veins present. The amputated tissues were replanted and revascularized by using only venous blood flow. The replanted part survival was 100% with excellent function of the digit. We conclude that a hand composite body part involving bone, tendon, soft tissues, and skin can survive replantation with a strict venous blood supply if sufficient good caliber, microvascular, venous-venous anastomoses are performed, granted that arterial inflow options are not available. This is an isolated case, yet introduces a new way of thinking regarding tissue replantation.

Reconstruction of Circulation in the Fingertip Without Vein Repair in Zone I Replantation

“…1,2 As the level of amputation becomes more distal, vessel diameter decreases and anastomosis becomes more technically challenging. 3,4 Indeed, the significant failure rate of fingertip replantation is due to venous insufficiency.…”

Techniques and survival incidence for revascularization of degloved fingers

“…Treatment methods include ray amputation, stump closure, reconstruction with pedicled/free regional or distant flaps, toe-to-hand transfer, or wraparound flap and replantation (Adani et al, 1998; Chen et al, 2001; Hsu et al, 1996; Ju et al, 2015; Kalimuthu and Herrmann, 2006; Kitidumrongsook et al, 2006; Noaman, 2012; Rodriguez-Lorenzo et al, 2009; Sears and Chung, 2011; Takeuchi et al, 2000). Treatment is technically challenging.…”

Reimplante de pulgar: casuística del Hospital Universitario Virgen del Rocío (Sevilla) entre los años 2005-2010

“…Desde el primer reimplante exitoso publicado en 1968 se han llevado a cabo cientos de reimplantes. Después de la amputación traumática de un tejido las metas fundamentales de la cirugía son la restauración de su forma anatómica y de su funcionalidad (1).…”