Distal Digit Replantation with an Efferent AV Anastomosis for Absent Venous Drainage

Distal digit amputation is a common injury of hand. If the amputation level is proximal to the lunula, replantation should be considered, since no other procedure will salvage the nail. During fingertip replantation, it is difficult to find an available vein on the amputee. Several methods have been provided to solve the problem including one artery anastomosis, leeches, paraungual incision…… etc. In this report, the contralateral digital artery was utilized to obtain venous drainage in all cases. The artery was anastomosed to the dorsal vein of the stump with a vein graft. Initially, the replantated part showed pinkish color with temperature above 32℃. Nevertheless, in 3 of the 4 cases, the replantated digits became cyanotic and cold with temperatures of 29.5-31.5℃ starting from the second to the fourth post-operative day. However, the color and temperature recovered after the fifth post-operative day. In one case, a small amount of necrosis was encountered which healed spontaneously without skin grafting.
All 4 cases showed slightly atrophic appearance during follow up. No cold intolerance was noted. Two-point discrimination was 7 mm on average.
These patients were very satisfied with the appearance and functional results. The efferent AV anastomosis provides an important option when no vein is available for distal digital replantation. Existing shunting systems of the fingertip which then provide channels for drainage may be the possible mechanism behind the success of this alternative method of anastomosis.