Nonarterialized venous replantation of part of amputated thumb-a case report and review of the literature
Research article published in Hand (New York, N.Y.) (2006)
Abstract
Since the first successful replantation of a human thumb reported by Komatsu and Tamai in 1968, thousands of severed digits and body parts have been successfully salvaged. Restoration of anatomic form and function are the goals of replantation after traumatic tissue amputation. Regardless of anatomic location, methods include microsurgical replantation and nonmicrosurgical replantation, such as composite graft techniques. Numerous techniques to maximize tissue survival after revascularization have been described, including "pocket procedures" to salvage composite grafts, interposition vein grafts, and medicinal leeches to name a few. Artery-to-venous anastomoses have been performed with successful "arterialization" of the distal venous system in fingertip replantation. Although there is documented survival of free venous cutaneous flaps, to our knowledge this is the first report of a replanted composite body part (bone, tendon, soft tissues, and skin) utilizing exclusively multiple, microvascular, nonarterialized venous-venous anastomoses. We present a patient with an isolated band saw fillet amputation to the back of the thumb at the metacarpal-phalangeal joint region, resulting in a composite graft composed of bone, tendon, soft tissue, and skin. The hand wound provided no viable regional arterial inflow source, but there were multiple good caliber superficial veins present. The amputated tissues were replanted and revascularized by using only venous blood flow. The replanted part survival was 100% with excellent function of the digit. We conclude that a hand composite body part involving bone, tendon, soft tissues, and skin can survive replantation with a strict venous blood supply if sufficient good caliber, microvascular, venous-venous anastomoses are performed, granted that arterial inflow options are not available. This is an isolated case, yet introduces a new way of thinking regarding tissue replantation.
Abstract sourced from PubMed (NCBI) for the cited record. See the original publication for the authoritative version.
Summary
Since the first successful replantation of a human thumb reported by Komatsu and Tamai in 1968, thousands of severed digits and body parts have been successfully salvaged.
Why This Matters for Hirudotherapy
This case report describes a patient with an isolated band saw amputation to the thumb who underwent successful replantation using exclusively nonarterialized venous-venous microvascular anastomoses, achieving 100% tissue survival with excellent digit function. The abstract mentions medicinal leeches as one of several recognized techniques in the literature for maximizing tissue survival after revascularization. This is relevant to ASH's domain insofar as leech therapy is acknowledged as an established adjunct in salvage of replanted tissues and composite grafts. However, leeches are mentioned only in passing as one of multiple available methods; this case did not actually employ leech therapy. The evidence concerns a novel venous-only surgical technique and represents a single isolated case.
Citation
Nonarterialized venous replantation of part of amputated thumb-a case report and review of the literature
Kalimuthu R et al. · Hand (New York, N.Y.), 2006
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