Primary Vein Grafting in Treatment of Ring Avulsion Injuries

Abstract

Out of 262 hands with total finger amputations treated by replantation of finger/fingers from January 2001 until January 2006, there were only 6 cases of type III ring avulsion injuries, all of which were replanted. Radical resection of the damaged part of the artery with primary vein grafting was used in each case; only 1 artery and 2 veins were anastomosed for each finger. The survival rate was 100%. Mean total active motion was 195 degrees (ranging from 175 degrees to 220 degrees ). Mean 2-point discrimination was 8.6 mm static (ranging from 4 to 11 mm) and 6.2 mm moving (ranging from 3 to 9 mm), and mean grip strength was 37.4 kg. We believe that liberal resection of the "zone of contusion" of vessels and primary vein grafting for arterial repair can improve the overall survival rate of replantation in type III ring avulsion injuries, and replantation can be attempted in majority of the cases; good hand function can be expected.

Replantation of Finger Avulsion Injuries: A Systematic Review of Survival and Functional Outcomes

“…We extracted TAM data from 13 studies (4,5,9–11,15–17,19,23,33,34,39), and we extracted static 2PD data from 9 studies (4,5,9,11,15–17,34,39). All studies that reported TAM and 2PD data also reported survival outcomes.…”

“…Only two studies (16,23) explicitly stated that replantation was attempted on a total of four patients having complete avulsion injuries involving the proximal phalanx or PIP joint. The remainder of the studies did not specify the number of patients undergoing replantation, if any, who had injury proximal to the FDS insertion (5,9,19,33). In addition, studies by Kay et al (10) and Sanmartin et al (33) each reported no functional difference based on the level of injury in relation to the PIP joint.…”

“…As surgeons continued to push the boundaries of microsurgery, novel techniques were proposed to manage the difficulties of salvaging avulsed digits. Reconstruction of vessels with long vein grafts (4,5), venous flow-through flaps (6), or transfer of vessels from adjacent fingers (7,8) enhanced survival of the avulsed digit. Several classification systems (9–11) have evolved to categorize patients according to anticipated treatment and functional outcome (Table 1).…”

“…Urbaniak has advocated for revision amputation to treat complete finger avulsion injuries (9,14). However, recent studies presenting functional outcomes after replantation of finger avulsion injuries have challenged this recommendation, with some authors achieving reasonable total active motion (TAM) approaching 200 degrees or greater after replantation of digital avulsion injuries (4,5,15,18–20). …”

Ring Avulsion Injury with Rupture of Both Digital Arteries Despite a Completely Intact Skin Envelope

“…Waikakul et al (2000) also encountered statistically significant better results in terms of survival when both arteries were reconstructed. Nevertheless, Hyza et al (2007) stated that, with only one artery and two veins anastomosed, the survival rate in their case series of six cases was 100%. Sufficient de´bridement of the stretched vascular structures always leads to significant artery and vein defects.…”