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Case Report Plastic and Aesthetic Research

Options for thumb revascularization: our

experience and literature review

Pradeoth Mukundan Korambayil , Prashanth Varkey Ambookan , Vinoth Kumar Dilliraj 2
1
1
1 Department of Plastic Surgery and Burns, Jubilee Institute of Surgery for Hand, Aesthetic and Microsurgery, Jubilee Mission Medical
College and Research Institute, P.B. No.737, Thrissur 680005, Kerala, India.
2 Department of Plastic Surgery, Vijaya Hospital, Chennai, India.
Address for correspondence: Dr. Pradeoth Mukundan Korambayil, Assistant Professor, Jubilee Institute of Surgery for Hand, Aesthetic and
Microsurgery, Jubilee Mission Medical College and Research Institute, Thrissur 680005, Kerala, India. E-mail: pradeoth@gmail.com

ABSTRACT
Traumatic injuries to the thumb resulting in segmental loss of a digital artery are not uncommon.
To bridge the gap and repair a transacted digital artery, the superficial palmar arch or the radial
digital artery of the index finger can be used to reconstruct the ulnar digital artery of thumb for
revascularization. Revascularization following segmental loss resulting from a crushed ulnar digital
artery of the thumb can be performed based on the superficial palmar arch or the radial digital artery of
the index finger, avoiding anastomosis at two sites and hence providing better results. The digital vein
from the index finger can also be used to enhance the venous return of the injured thumb. However,
because of known variability in the palmar arch, intraoperative verification is needed to ensure the
safe transfer of the arch or the radial digital artery of the index finger. The aim of this article is to
discuss the possibilities for thumb revascularization, using a case report in which the injured thumb
was revascularized with a superficial palmar arch.
Key words:
Radial digital artery index finger, superficial palmar arch, thumb revascularization, ulnar digital artery
thumb

INTRODUCTION challenge to the reconstructive surgeon. Primary repair
of the digital artery may be difficult and may be achieved
The decision whether to proceed with revascularizing by shortening the proximal phalangeal bone if there are
the thumb following a crush injury depends on several associated fractures. Repair of the digital artery is likely to
factors, including the mechanism of injury, the patient’s require vein grafting, as significant segmental loss of the
age, occupation and hand dominance, and overall medical digital artery often results from injuries in this area. To
condition and intraoperative assessment of the injured bridge the gap and repair a transected digital artery, the
structures. Crush injuries at the base of the thumb palmar arch or radial digital artery of the index finger can
involving loss of digital artery segments can present a be used to reach the ulnar digital artery of the thumb
without a vein graft. In addition, a vein from the index
Access this article online finger can be used to achieve venous drainage of the
thumb.
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Website:
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CASE REPORT

DOI: A 60-year-old male sustained a mutilating injury to his
10.4103/2347-9264.135563 dominant right thumb [Figures 1-3]. A radiograph of the
right hand in the anteroposterior view showed a fracture

Plast Aesthet Res || Vol 1 || Issue 1 || Jun 2014 37