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Figure 10: Options for thumb revascularization

important consideration and warrants further evaluation
[7]
before attempting a clinical transfer.
The principle of transposing the radial digital artery or
Figure 9: Schematic representing transfer of the palmar arch or radial superficial palmar arch could very well be used in cases
digital artery of the index finger for revascularization of the thumb of amputation at the level of the base of the thumb,
where venous grafts may be avoided for establishing the
vessel shift of the radial or ulnar arteries, and forming an circulation.
arteriovenous fistula [Figure 10].
CONCLUSION
The advantage of the vein graft procedures is that
there is no need to sacrifice the palmar arch. The
disadvantages are the need for two anastomoses, and Revascularizing the thumb is a challenging and rewarding
that the proximal part of the injured artery can be in experience for the plastic surgeon. Knowledge of the
spasm since it is near to the zone of trauma. This can superficial palmar arch and its anatomical variability
result in an unfavorable outcome following anastomosis, are critical for successful revascularization. Therefore,
with the need for further revision procedures and bridging the vascular gap to repair the transected ulnar
additional incisions for vein graft harvest. The advantages digital artery of the thumb, superficial palmar arch or the
of the transfer of superficial palmar arch or radial digital radial digital artery of the index finger could be safely
artery for thumb revascularization over vein grafts are transferred distally for revascularisation.
the need for just one anastomosis, which reduces the
incidence of thrombosis, and that the artery borrowed REFERENCES
for anastomosis is out of the zone of trauma, resulting
in better outcomes. The disadvantage of this procedure 1. Hazani R, Elston J, Brooks D, Wilhelmi BJ. Bridging the gap in hand replantation:
use of the common digital artery for completion of the superficial palmar
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chance of this is low as one vascular bundle is retained 2. Gellman H, Botte MJ, Shankwiler J, Gelberman RH. Arterial patterns of the
and there are additional arterial perforators from the deep and superficial palmar arches. Clin Orthop Relat Res 2001;383:41‑6.
metacarpal arteries. 3. Dhar P, Lall K. An atypical anatomical variation of palmar vascular pattern.
Singapore Med J 2008;49:e245‑9.
Another method with which to salvage the thumb 4. Richard D, Goldner JR. Urbaniak, replantation. In: Wolfe SW, editor. Green’s
following crush or avulsion injuries is to shift the Operative Hand Surgery. 6th ed. Philadelphia, U.S.A: Churchill Livingstone;
2010. p. 1591‑2.
undamaged arteries (radial or ulnar). Disadvantages of 5. Hawary MB, Cardoso E, Mahmud S. Afferent arteriovenous fistula in thumb
[4]
this method are scar contracture, size mismatch of the revascularization. Ann Saudi Med 1997;17:99‑100.
vessels, and concomitant damage to the utilized vessel. 6. Inoue G, Tamura Y. The use of an afferent arteriovenous fistula in digit
replantation surgery: a report of two cases. Br J Plast Surg 1991;44:230‑3.
Some authors have suggested creating an arteriovenous 7. Morris SF, MacGill KA, Taylor GI. Scalp replantation by arterialised venous
fistula. This method is usually used when there is network flow‑through. Br J Plast Surg 1992;45:187‑92.
[5]
no suitable artery in the devascularized part. Better
results are obtained when the volar veins are used for How to cite this article: Korambayil PM, Ambookan PV, Dilliraj VK.
anastomosis and when there is less tension on the Options for thumb revascularization: our experience and literature
review. Plast Aesthet Res 2014;1:37-40.
anastomosis between the proximal volar digital artery and
the dorsal vein. Morris et al. have suggested that the Source of Support: Nil, Conflict of Interest: None declared.
[6]
presence or absence of venous valves appears to be an Received: 27-02-2014; Accepted: 28-05-2014

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