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Advantages of Using Volar Vein Repair in Finger Replantations
Fatih Kabakas, MD; Ismail Bulent Ozcelik, MD; Berkan Mersa, MD; Husrev Purisa, MD; Ilker Sezer, MD
Hand and Microsurgery, Ist-El Hand Surgery Microsurgery, Istanbul, Turkey

Providing adequate venous outflow is essential in finger replantation surgeries. For a successful result, the quality and quantity of venous repairs should be adequate to drain arterial inflow. Increasing the repaired vein:artery ratio also increases the success of replantation. The volar skin, covering the volar vein, is less likely to be avulsed during injury and is also less likely to turn necrotic, than dorsal skin, after the replantation surgery. Primary repair of dorsal veins can be difficult due to tightness ensuing from arthrodesis of the underlying joint in flexion. In multiple finger replantations, repairing the volar veins after arterial repair and continuing to do so for each finger in the same way without changing the position of the hand and surgeon save time.

The total number of veins repaired in 366 fingers was 1257 (mean of 3.4 per finger; Excluding zone I patients in whom only volar veins can be repaired, the mean per finger increased to 3.9. Six hundred and seventy-seven volar veins were repaired in 366 fingers (mean of 1.8 per finger). A total of 580 dorsal veins were repaired in 366 fingers (mean of 1.6 per finger). Excluding zone I injuries, the mean number of dorsal vein repairs per finger increased to 2.1. The maximum number of veins per finger was seven (four dorsal and three volar) and the minimum number was one. The total number of arteries repaired in 366 fingers was 420 (mean of 1.1 per finger; The survival rate was lowest for ring avulsions (68%) and highest for zone I replantations (88%). Proximal interphalangeal (PIP) joint arthrodesis was performed in 32 fingers. Distal interphalangeal (DIP) joint arthrodesis was performed in 55 fingers. One hundred and twenty-three fingers were injured in multi-finger amputations. Dorsal skin necrosis was observed in 36 patients but this healed without causing any circulatory problems in all cases.

The aim of this study was not to demonstrate a statistically significant increase in survival rates with volar vein repairs because there are many other factors affecting survival rates after replantation. A comparative study may also fail to show increased survival rates with volar vein anastomosis because groups of injuries are rarely homogeneous. In conclusion, volar vein repair in finger replantation gives the hand surgeon the opportunity to repair more vessels to save the replanted digit with technical advantages, and may be associated with a greater possibility of survival.

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