J reconstr Microsurg
DOI: 10.1055/s-0038-1625987
Letter to the Editor
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Reply to a Letter to the Editor: Anatomical Study of the Fingertip Artery in Tamai Zone I: Clinical Significance in Fingertip Replantation

Yong Seok Nam
1  Catholic Institute for Applied Anatomy, Department of Anatomy, College of Medicine, The Catholic University of Korea, Seoul, Korea
,
Young Joon Jun
2  Department of Plastic and Reconstructive Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea
,
In-Beom Kim
1  Catholic Institute for Applied Anatomy, Department of Anatomy, College of Medicine, The Catholic University of Korea, Seoul, Korea
,
Hyun Ho Han
3  Department of Plastic and Reconstructive Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Publikationsverlauf

14. Dezember 2017

23. Dezember 2017

Publikationsdatum:
02. Februar 2018 (eFirst)

Anatomical Study of the Fingertip Artery in Tamai Zone I: Clinical Significance in Fingertip Replantation

Letter to the Editor: Anatomical Study of the Fingertip Artery in Tamai Zone I: Clinical Significance in Fingertip Replantation

I thank Drs. Wang, Wei, and Wei for the interest in our article titled “Anatomical study of the fingertip artery in Tamai zone I: Clinical significance in fingertip replantation.”[1] I agree with the vein issue that they mentioned. However, the purpose of the study was not to examine venous anatomy but instead to precisely define the arterial system. The previous anatomical data regarding the arteries were scarce and discrepant. For beginners and those with little replantation experience, it is difficult to locate the artery, and impossible to take a step forward without finding the artery.

I am aware that it is important to identify the venous pattern in Tamai zone I for use in clinical practice. However, since the vein is located superficially and adjacent to the dermis, it is possible to identify its course by direct observation just before or during the operation. Therefore, an anatomical description of the vein is less useful than that of the artery, and experienced surgeons are more likely to have the practical know-how to find veins. Moreover, even if venous patterns can be determined with anatomical information, the veins are often difficult to connect because of crushing-wound conditions or technical problems.

What I provided in the Discussion section were suggestions for various options if the attempt to find the vein fails. This was not meant to imply that it is not necessary to connect the veins. As I stated in the article, based on the anatomical study, an additional artery can be used for venous drainage by adaptation of reverse flow.[1] In addition, it is possible to use the intramedullary space for venous drainage, although Wang et al may disagree. Recent articles have described intramedullary venous drainage.[2] [3] Drilling was used to create a route in the medullary space and a fenestrated needle was used to increase the amount of venous drainage.[2] Chen et al[3] also demonstrated the possibility of intramedullary drainage with artery-only replantation and achieved a >90% success rate. Good results were even obtained without bone fixation because the medullary space of the bone in an amputated finger is often open.

If the vein cannot be connected, various options can be tried. Keep in mind, however, that all these possibilities regarding the veins depend on connecting the arteries.