Abstract:

Objective To explore the feasibility and effectiveness of veno-arteriolization of bilateral proper digital artery for repairing severed fingers by comparing with traditional veno-arteriolization of single proper digital artery. Methods Forty qualified patients with severed fingers (40 severed fingers) who were admitted from February, 2008 to October, 2012 were selected. They all received veno-arteriolization after failing to anastomose arteries of finger for several times. Patients were randomly divided into two groups, i.e. the trial group (n=20) and control group (n=20). Patients of the trial group underwent veno-arteriolization of bilateral proper digital artery. The proximal non-superiorty digital artery was anastomosed to the dominant digital artery and then the proximal dominant digital artery was anastomosed to the distal digital vein (palmar vein for replantation of proximal or middle segment of finger and lateral vein for replantation of distal segment of finger). Patients of the control group underwent veno-arteriolization of single proper digital artery. The proximal dominant digital artery was directly anastomosed to the distal digital vein. The differences of gender, age, cause of injury, duration of disease, injured finger, lesion segments, failure times of anastomosing artery of finger, fracture, and nerve damage of two groups were not statistically significant (P>0.05) and comparable. Results Replanted fingers of all patients of the trial group were survived and achieved primary healing. Five replanted fingers of the control group necrotized. And 33 patients were successfully followed up for 6 to 14 months. Replanted fingers of 19 patients of the trial group had satisfactory appearance. The finger pulp was plump with good flexibility and the finger body did not atrophied significantly. The nail of the trial group grew evenly and the length of nail was (15.4±2.2) mm, which was significantly longer than that of the control group (P<0.05). The two point discrimination was (4.8±0.3) mm and was significantly shorter than that of the control group(P<0.01). The motion of joint was (86±5)° and was significantly higher than that of the control group (P<0.05). The sensation measurement was S2-S4 and the average of which was S3+, which was significantly higher than that of the control group (P<0.05). According to the Tamai's classification, the results of 15 cases were excellent and 4 cases were good. The rate of excellent and good results was 100%. The difference of the rate of excellent and good results of two groups was statistically significant (χ2=8.420, P<0.05). Finger bodies of 14 patients of the control group (except necrotic fingers) mildly atrophied. The nail grew unevenly and the length of nail was (11.5±2.0) mm. The two point discrimination was (7.6±0.4) mm. The motion of joint was (65±3)°. The sensation measurement was S2-S3+ and the average of which was S2. According to the Tamai's classification, the results of 7 cases were excellent; 4 cases were good; and 3 cases were fair. The rate of excellent and good results was 78.6%. Conclusion The veno-arteriolization of bilateral proper digital artery amplifies the effects of veno-arteriolization of single proper digital artery, non-traumaticly and rapidly disables valves, increases effective perfusion, significantly increases the survival of replanted fingers, promotes the growth of nail and recovery of sensation, increases the motion of digital joints, and provides a more effective remedial method for repairing severed fingers after normal methods have failed.

Key words: veno-arteriolization, reconstructive surgical procedures, replantation of severed finger