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Advantages of using volar vein repair in finger replantations

Replantation surgery is challenging because the surgeon
may have a limited amount of tissue to deal with, and it is
always necessary to act quickly. Many factors affect the
outcome of replantation, but venous insufficiency is a
particular problem that complicates finger replantation
surgery. Most surgeons repair bone and tendons first, then
the arteries, leaving venous repair for the end when the
surgeon is tired after hours of extremely intense work.
Providing adequate venous return in an amputated finger is,
however, one of the most important stages in replantation,
and it is known that a higher number of repaired veins increase
survival rates.1 Dorsal veins are selected as they are
often used and their repair is reliable. Volar veins are
selected only when there is no other choice (such as in Tamai zone I amputations), and in some volar oblique amputations
where dorsal veins are unavailable in the
amputee (Figure 1). Most surgeons do not seek volar veins if
dorsal veins are available. However, we always try to
perform volar vein repairs regardless of the number of
dorsal vein repairs. The aim of this study was to highlight
the technical advantages of using volar veins in replantation
surgery and the positive effect this can have on survival.