Use of an Intra-Arterial Catheter as a Provisional Conduit for Regulated Outflow Management in the Setting of Artery-Only Digital Replantation
02 September 2016
14 November 2016
27 November 2017 (eFirst)
Successful replantation of distal digital segments necessitates the establishment of sufficient outflow to minimize congestion and progressive tissue necrosis. In cases where only arterial anastomosis is feasible, an artificial outlet must be provided to maintain physiological requirements until microvenous circulation regenerates. This can be accomplished using any number of “exsanguination techniques” designed to facilitate egress through ongoing passive blood loss. Although reportedly effective, these measures are imprecise and carry a substantial risk of infection, scarring, and/or uncontrolled hemorrhage. Herein, we describe a preemptive alternative for provisional venous drainage, whereby direct catheterization of a distal arterial branch is used to enhance the precision of outflow management following artery-only digital replantation. The establishment of intravascular access, using the technique described, permits remote manipulation of the microcirculatory environment through timed administration of heparinized saline and regulated removal of controlled volumes of blood.
Keywordsarterial catheterization - artery-only replantation - artificial conduit - digital replantation - fingertip amputation
There are no financial disclosures, commercial associations, or any other conditions posing a conflict of interest to report for any of the authors. Informed consent was obtained from the individual whose photographs were used in the preparation of this manuscript.
- 1 Sebastin SJ, Chung KC. A systematic review of the outcomes of replantation of distal digital amputation. Plast Reconstr Surg 2011; 128 (03) 723-737
- 2 Fucher G, Henderson HR, Maneau M, Merle M, Braun FM. Distal digital replantation: one of the best indications for microsurgery. Int J Microsurg 1981; 3 (04) 263-270
- 3 Whitaker IS, Oboumarzouk O, Rozen WM. , et al. The efficacy of medicinal leeches in plastic and reconstructive surgery: a systematic review of 277 reported clinical cases. Microsurgery 2012; 32 (03) 240-250
- 4 Kim SW, Han HH, Jung SN. Use of the mechanical leech for successful zone I replantation. Sci World J 2014; 2014: 105234
- 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 (06) 2043-2051