Abstract
Successful replantation of distal digital segments necessitates the establishment
of sufficient outflow to minimize congestion and progressive tissue necrosis. In cases
where only arterial anastomosis is feasible, an artificial outlet must be provided
to maintain physiological requirements until microvenous circulation regenerates.
This can be accomplished using any number of “exsanguination techniques” designed
to facilitate egress through ongoing passive blood loss. Although reportedly effective,
these measures are imprecise and carry a substantial risk of infection, scarring,
and/or uncontrolled hemorrhage. Herein, we describe a preemptive alternative for provisional
venous drainage, whereby direct catheterization of a distal arterial branch is used
to enhance the precision of outflow management following artery-only digital replantation.
The establishment of intravascular access, using the technique described, permits
remote manipulation of the microcirculatory environment through timed administration
of heparinized saline and regulated removal of controlled volumes of blood.
Keywords
arterial catheterization - artery-only replantation - artificial conduit - digital
replantation - fingertip amputation
