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Intramedullary Venous Drainage System for Distal Finger Tip Replantations
H. Purisa, MD1; Muhammed besir Ozturk, MD2; F. Kabakas, MD3; IB Ozcelik, MD1; Berkan Mersa, MD1; I. Sezer, MD1
1Hand and Microsurgery, ist-el hand surgery microsurgery, Istanbul, Turkey, 2Medeniyet University, istanbul, Turkey, 3Hand and Microsurgery, GOP Hospital, Istanbul, Turkey

Introduction
The number of venous anastomosis performed in fingertip replantations is one of the most important factors affecting the success of the fingertip replantation. Vascular anastomosis especially venous anastomosis is difficult in Tamai zone-1 level of fingertip amputations, because of the small vessel diameters, and venous anastomosis often can not be done. To overcome this problem many arterial only replantation techniques have been described in the literature including arteriovenous anastomosis, creating arteriovenous or venocutaneus fistula, manual milking and massage, puncturing, fish mouth incision and using medicinal leeches. The medullary cavity of the distal phalanx has been shown to be a reliable way for venous return in the fingertip. In this study, we described the venous drainage system that we developed to use in distal fingertip replantations and we evaluated the results of our patients using this system between 2008-2013.

Patients and Methods
24 fingertips of 22 patients with tamai zone 1 fingertip amputations that appropriate vein could not be found for venous anastomosis were included in this study. In all replantations venous return was maintained only with using intramedullary venous drainage system that we described in this study. System & Surgical Technique Intramedullary venous drainage system was created drilling 0,1 mm holes on a standard 18G needle, in a circular manner with one hole drilled in every 0,5 cm rotating 90 degrees. By drilling the holes along the length of the needle, a connection was created between the medullary cavity of the amputated part and the medullary cavity of distal/middle phalanx of the affected finger. This system was used for venous return and bone stabilization in all cases (figure 1).

Result
Complete replantation success was achieved in 21 of 24 fingertips (88%), partial necrosis was observed in one case (4%) and complete necrosis was observed in 2 cases (8%). Venous congestion was observed in 4 cases in early postoperative period and in all cases it disappeared following washing the inside of the needle with heparinized saline solution. We did not observe any partial or complete necrosis due to venous congestion.

Conclusion
We think that the venous drainage system we developed is a good alternative in maintaining the venous return of tamai zone 1 fingertip replantation's if venous anastomosis cannot be established properly using standard technique. This technique eliminates the need of blood transfusions especially in multiple finger replantation's. Figure 1.


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