Dorsal approach for vascular repairs in distal finger replantations

Distal finger replantation has become a routine operation
in many hand units. Although controversy exists for the
benefits of fingertip replantation, a successful distal finger
replantation preserves the finger length and nail and
provides good and sensate skin cover. The results are
superior to stump revision and other reconstruction methods
both functionally and cosmetically. Longer operation
times, longer hospital stays, longer time off work, and
higher costs are main drawbacks of this operation.1
Technical difficulties are another important drawback
of this operation. The vessel sizes are about 0.8 mm to
0.3 mm.2,3 The vessels are thin walled and their flexibility
is less compared to proximal replantations. 11/0 sutures are
needed in most cases. Tension is not tolerated by this very
thin vessels during repair. The bulk of the pulp tissue precludes
a wide view of the repair site. Retraction of skin and
pulp tissue increases tension on the anastomosis. It is difficult
to use microvascular clamps in this narrow field of
vision. The artery is in the deepest location just over the
We use dorsal approach to overcome some of these
technical difficulties. Dorsal approach has been described
by Foucher and Norris for distal thumb replantations.4
Since then very little emphasis is found in the literature
about dorsal approach.5,6
The purpose of this report is to present the results of
25 cases of distal finger replantations, performed by dorsal
approach for vascular repairs. The details of this technique
and its benefits are discussed with a literature review.