Use of an Intra-Arterial Catheter as a Provisional Conduit for Regulated Outflow Management in the Setting of Artery-Only Digital Replantation

Abstract

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.

Keywords

arterial catheterization - artery-only replantation - artificial conduit - digital replantation - fingertip amputation

Note

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.

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