Secondary Subdermal Pocket Procedure for Venous Insufficiency After Digital Replantation/Revascularization

The Efficacy of Subdermal Pocket Procedure in Fingertip Replantation With Composite Graft

BACKGROUND

Microsurgical replantation of fingertip amputation is sometimes difficult because of a lack of available vessels. Composite grafting is an alternative method for nonvascularized replantation, but it has a limited success rate. The subdermal pocket (SDP) procedure is proposed to increase the survival of composite graft.

AIM AND OBJECTIVES

We aimed to compare the success rate of the composite graft used in fingertip replantation with or without application of the SDP procedure.

PATIENTS AND METHODS

From 2000 to 2020, 29 fingertip amputations (28 complete amputations, 1 near-complete amputation) from 28 patients were included. Five of the fingertip amputations were classified as Ishikawa zone Ib and 24 as Ishikawa zone II. Seventeen fingers underwent replantation with composite graft plus SDP procedure, whereas the remaining 12 fingers received replantation with composite graft only.

RESULTS

The overall success rate was 70.59% (12 of 17) in the SDP group and 41.67% (5 of 12) in the composite graft-only group (P = 0.119; odds ratio, 3.36). In the subgroup of Ishikawa zone II fingertip amputations, the success rate was 66.67% (10 of 15) in the SDP group and 22.22% (2 of 9) in the composite graft-only group (P = 0.035; odds ratio, 7.0).

CONCLUSIONS

The SDP procedure could increase the success rate of fingertip replantation with composite graft, especially for Ishikawa zone II amputations.

External bleeding versus dermal pocketing for distal digital replantation without venous anastomosis

Venous congestion in distal digital replantations is a common problem as suitable veins are not always available. We compared two methods of venous decongestion, external bleeding ( n = 15) and dermal pocketing ( n = 28) carried out when venous anastomosis was not possible. The findings of this small study suggest that neither method of venous decongestion is clearly better than the other. Level of evidence: IV.

Cross-finger subdermal pocketplasty as a salvage procedure for thumb tip replantation without vascular anastomosis: a case report

Objectives Fingertip amputation is often encountered in emergency departments, especially in hospitals located near industrial areas. Replantation of the fingertip can be considered when the normal architecture is preserved in cases of sharp amputation. The goal of replantation is to preserve cosmesis and function, especially for the thumb because of its involvement in grasping and the key pinch. Even when microsurgical vascular anastomosis is applied, the absence of venous anastomosis along with the high rate of failure of arterial anastomosis in zone 1A fingertip amputation may lead to replantation failure. Methods We herein present a case report of thumb tip amputation salvaged via a modified cross-finger technique. The recipient site was on the ipsilateral radial side of the intermediate phalanx of the middle finger. Results The thumb tip was successfully replanted with no vascular anastomosis, and this new technique prevented stiffness in the metacarpophalangeal and interphalangeal joints of the thumb and middle finger. Conclusions This procedure can be performed in local clinics and emergency departments without the need for arterial and venous anastomoses.

Combined Subdermal Pocket Procedure and Abdominal Flap for Distal Finger Amputations in a Toddler

A girl (aged 1 year and 9 months) sustained traumatic amputation to her middle and ring fingers (zone 1C) by a cup-sealing machine. Full-thickness dorsal skin burn over amputated fingertips was also noted. Emergent finger replantation was performed. Following bone fixation, bilateral digital arteries and nerves were repaired. After complete debridement of the necrotic dorsal skin, the extensor tendon and joint were exposed. Moreover, all dorsal veins were destroyed. The pulps (middle and ring fingers) were de-epithelialized and inserted into the subdermal pocket over her left abdomen. The 2 raised skin flaps were transferred to reconstruct the dorsal skin defects. Division of the replanted finger from abdomen was performed at the 14th postoperative day. The fingers survived completely. Good functional and aesthetic outcomes were achieved.