Anatomical Study of the Fingertip Artery in Tamai Zone I: Clinical Significance in Fingertip Replantation
14 March 2016
07 July 2016
05 September 2016 (online)
Background There are a few previous studies of the vascular anatomy of the fingertips. The aim of this study was to evaluate this anatomy and the distribution of fingertip arteries.
Patients and Methods A total of 31 cadaveric hands were used for evaluation of the vascular pattern of the fingertips on X-ray images obtained using a radiopaque material. We analyze the anatomy of the fingertip arteries, and classified it into three types in Tamai zone I. If only one dominant artery branched off from the distal transverse palmar arch, it was classified as type I. If the fingertip had branches of two dominant arteries, it was classified as type II, and if the fingertip had branches of three or more dominant arteries, it was classified as type III.
Results The incidence of type I was 27%, that of type II was 28%, and the incidence of type III was 45%, the latter being the most frequent. In addition, we analyzed the pattern in each finger. The frequency of type III decreased from the index finger to the little finger, and the frequencies of types I and II increased from the index finger to the little finger.
Conclusion Type III was the most common type in fingers, and its frequency decreased from the index finger to the little finger.
- 1 Venkatramani H, Sabapathy SR. Fingertip replantation: Technical considerations and outcome analysis of 24 consecutive fingertip replantations. Indian J Plast Surg 2011; 44 (2) 237-245
- 2 Tamai S. Twenty years' experience of limb replantation—review of 293 upper extremity replants. J Hand Surg Am 1982; 7 (6) 549-556
- 3 Hirase Y. Salvage of fingertip amputated at nail level: new surgical principles and treatments. Ann Plast Surg 1997; 38 (2) 151-157
- 4 Allen MJ. Conservative management of finger tip injuries in adults. Hand 1980; 12 (3) 257-265
- 5 Hsu CC, Lin YT, Moran SL, Lin CH, Wei FC, Lin CH. Arterial and venous revascularization with bifurcation of a single central artery: a reliable strategy for Tamai zone I replantation. Plast Reconstr Surg 2010; 126 (6) 2043-2051
- 6 Hattori Y, Doi K, Ikeda K, Estrella EP. A retrospective study of functional outcomes after successful replantation versus amputation closure for single fingertip amputations. J Hand Surg Am 2006; 31 (5) 811-818
- 7 Sebastin SJ, Chung KC. A systematic review of the outcomes of replantation of distal digital amputation. Plast Reconstr Surg 2011; 128 (3) 723-737
- 8 Komatsu S, Tamai S. Successful replantation of a completely cut-off thumb. Plast Reconstr Surg 1968; 42 (4) 374-377
- 9 Chen KK, Hsieh TY, Chang KP. Tamai zone I fingertip replantation: is external bleeding obligatory for survival of artery anastomosis-only replanted digits?. Microsurgery 2014; 34 (7) 535-539
- 10 Coleman SS, Anson BJ. Arterial patterns in the hand based upon a study of 650 specimens. Surg Gynecol Obstet 1961; 113: 409-424
- 11 Edwards EA. Organization of the small arteries of the hand and digits. Am J Surg 1960; 99: 837-846
- 12 Chaudakshetrin P, Kumar VP, Satku K, Pho RWH. The arteriovenous pattern of the distal digital segment. J Hand Surg [Br] 1988; 13 (2) 164-166
- 13 Endo T, Kojima T, Hirase Y. Vascular anatomy of the finger dorsum and a new idea for coverage of the finger pulp defect that restores sensation. J Hand Surg Am 1992; 17 (5) 927-932
- 14 Strauch B, de Moura W. Arterial system of the fingers. J Hand Surg Am 1990; 15 (1) 148-154
- 15 Kim SW, Han HH, Jung SN. Use of the mechanical leech for successful zone I replantation. ScientificWorldJournal 2014; 2014: 105234 DOI: 10.1155/2014/105234.
- 16 Koshima I, Soeda S, Moriguchi T, Higaki H, Miyakawa S, Yamasaki M. The use of arteriovenous anastomosis for replantation of the distal phalanx of the fingers. Plast Reconstr Surg 1992; 89 (4) 710-714
- 17 Koshima I, Yamashita S, Sugiyama N, Ushio S, Tsutsui T, Nanba Y. Successful delayed venous drainage in 16 consecutive distal phalangeal replantations. Plast Reconstr Surg 2005; 115 (1) 149-154
- 18 Matsuda M, Chikamatsu E, Shimizu Y. Correlation between number of anastomosed vessels and survival rate in finger replantation. J Reconstr Microsurg 1993; 9 (1) 1-4
- 19 Koshima I. Atypical arteriole anastomoses for fingertip replantations under digital block. J Plast Reconstr Aesthet Surg 2008; 61 (1) 84-87
- 20 Tobias JD, Ross AK. Intraosseous infusions: a review for the anesthesiologist with a focus on pediatric use. Anesth Analg 2010; 110 (2) 391-401
- 21 Chen HC, Tang YB, Noordhoff MS. Bone marrow as a means of venous drainage for a microvascular osteocutaneous flap. Surgery 1991; 110 (5) 854-859
- 22 Kamei Y, Aoyama H, Yokoo K , et al. Possibility of venous return through bone marrow in the free fibular osteocutaneous flap. Ann Plast Surg 2001; 47 (4) 450-452
- 23 Jose RM, Roy DK, Wright PK, Erdmann M. Hand surface area—do racial differences exist?. Burns 2006; 32 (2) 216-217