Multi-segment inverted Y-shaped vein transplantation using anterior lateral malleolar venous network for repair of amputated palm injury distal to superficial palmar arch_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

ZHANG Zhao ¹ , WANG Yanyan ² , Gao Fei ¹ , PAN Yuehai ¹ , Huang Heng ¹ , LU Chao ¹ , Wang Guozhong ¹ , Qu Zhigang ¹ ,  BI Benjun ¹

1. Department of Hand and Foot Surgery, Affiliated Hospital of Qingdao University, Shandong Qingdao, 266000, P. R. China;
2. Department of Medical Oncology, Qingdao Central Hospital, University of Health and Rehabilitation Sciences (Qingdao Central Hospital), Shandong Qingdao, 266000, P. R. China;

Corresponding author：

BI Benjun, Email: bibenjun@163.com

Keywords：

Anterior lateral malleolar venous network; superficial palmar arch; vascular grafting; amputated palm injury; inverted Y-shaped vein

DOI：

10.7507/1002-1892.202503002

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Objective To explore the effectiveness of multi-segment inverted Y-shaped vein transplantation using the anterior lateral malleolar venous network for repair of amputated palm injury distal to the superficial palmar arch. Methods Between September 2018 and July 2023, 5 patients with amputated palm injury distal to the superficial palmar arch were treated. There were 3 males and 2 females with an average age of 35.4 years (range, 29-52 years). The time from injury to admission was 1-6 hours (mean, 3.2 hours). The multi-segment inverted Y-shaped vein transplantation in the anterior lateral malleolar venous network were used to repair the common and proper palmar digital arteries; the another anterior lateral malleolar venous network was used to repair the dorsal hand vein. The soft tissue defect of dorsal hand in 1 patient was repaired with the pedicled ilioinguinal flap, and the wound at the donor site was directly sutured. Postoperative treatment included anti-infection therapy, antispasmodic therapy, and thrombosis prevention measures. Results The partial necrosis of the fingertip of the thumb occurred in 1 case, and the marginal necrosis of the abdominal flap after operation. The remaining fingers showed good blood supply with normal tension. The incision at donor site of the abdominal flap healed by first intention. All patients were followed up 8-41 months (median, 19 months). At last follow-up, the hand contour was satisfactory; the grasping function, opposition function, and proprioception recovered, and two-point discrimination ranged from 5 to 7 mm (mean, 6 mm). According to the upper extremity function evaluation criteria issued by Hand Surgery Society of the Chinese Medical Association, the functional outcomes were excellent in 3 cases, good in 1 case, and fair in 1 case. Conclusion The multi-segment inverted Y-shaped vein transplantation using the anterior lateral malleolar venous network for repairing defects in the common digital palmar arteries and proper digital arteries distal to the superficial palmar arch offers advantages such as superficial location, flexible harvesting, and high compatibility. This technique has demonstrated favorable outcomes in complex transmetacarpal amputation reconstruction.

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2.	王伟明, 封帆, 龙文浩. 血管移植在断指再植中的应用研究. 深圳中西医结合杂志, 2020, 30(16): 13-14,199.
3.	廖军, 李新萍, 潘爱群, 等. 改进血管移植操作程序在末节断指再植中的应用. 实用手外科杂志, 2021, 35(4): 525-527.
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6.	潘达德, 顾玉东, 侍德, 等. 中华医学会手外科学会上肢部分功能评定试用标准. 中华手外科杂志, 2000, 16(3): 130-135.
7.	Georgescll AV. ALL-in-one reconstruction of the mangled upper extremity. 中华显微外科杂志, 2021, 44(2): 121-122.
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10.	Van Handel AC, Pet MA. Fingertip replantation: technique details and review of the evidence. Hand Clin, 2021, 37(1): 53-65.
11.	Thomson CH, Shah AK, Köhler G, et al. Mid-palm hand amputation: reconstruction of the superficial palmar arch. J Plast Reconstr Aesthet Surg, 2013, 66(8): 1155-1157.
12.	吴晋宝, 秦月琴, 程心恒, 等. 足背静脉的分布. 解剖学报, 1983, 14(3): 242-248.
13.	吴信举, 汤浩, 谢久虎, 等. 血管移植桥接在手指关节部位断指再植中的应用. 实用手外科杂志, 2021, 35(4): 436-438.
14.	Krishnakumar KS, Petkar K, Lateef S, et al. Palmar arch reconstruction using dorsal venous arch of foot for revascularisation of multiple digits. Indian J Plast Surg, 2014, 47(1): 120-123.
15.	于胜军, 马振杰, 李晓, 等. 足背外侧静脉网移植修复手掌浅弓缺损八例. 中华显微外科杂志, 2022, 45(6): 629-633.
16.	赵强, 巨积辉, 李雷, 等. 移植自体浅静脉网桥接修复手部掌深浅弓损伤. 实用手外科杂志, 2008, 22(3): 167-168.
17.	刘良燚, 杨延军, 王克列, 等. 前臂掌侧浅静脉网的解剖学特点和临床应用. 中华显微外科杂志, 2011, 34(5): 420-421.
18.	于胜军, 孙明, 李京宁, 等. 带旋股外动脉内侧降支股前外侧皮瓣在毁损性断掌再植中的应用. 中华显微外科杂志, 2005, 28(1): 65-66.
19.	葛健君, 叶锋, 兰行远, 等. 使用自体血管移植修复失功自体动静脉内瘘的临床疗效分析. 中外医疗, 2022, 41(29): 5-9.
20.	Del Piñal F. An update on the management of severe crush injury to the forearm and hand. Clin Plast Surg, 2020, 47(4): 461-489.

1. Cavadas PC. Multilevel replantation of the palm and digits. Plast Reconstr Surg, 2008, 122(2): 95-96.
2. 王伟明, 封帆, 龙文浩. 血管移植在断指再植中的应用研究. 深圳中西医结合杂志, 2020, 30(16): 13-14,199.
3. 廖军, 李新萍, 潘爱群, 等. 改进血管移植操作程序在末节断指再植中的应用. 实用手外科杂志, 2021, 35(4): 525-527.
4. Falkner F, Mayer SA, Thomas B, et al. Acellular human placenta small-diameter vessels as a favorable source of super-microsurgical vascular replacements: a proof of concept. Bioengineering (Basel), 2023, 10(3): 337. doi: 10.3390/bioengineering10030337.
5. 李海, 刘志远, 聂开瑜, 等. 自体血管移植桥接巨大旋股外侧动脉穿支皮瓣修复头部大面积皮肤软组织缺损. 中华创伤杂志, 2021, 37(12): 1074-1077.
6. 潘达德, 顾玉东, 侍德, 等. 中华医学会手外科学会上肢部分功能评定试用标准. 中华手外科杂志, 2000, 16(3): 130-135.
7. Georgescll AV. ALL-in-one reconstruction of the mangled upper extremity. 中华显微外科杂志, 2021, 44(2): 121-122.
8. Sahu RK, Kala PC, Dixit PK, et al. Finger pulp reconstruction with thenar flap: Aesthetic and functional outcome. Chin J Traumatol, 2020, 23(5): 307-310.
9. Pamuk Ç. Supermicrosurgical experience pertaining to replantation of tamai zone 1 fingertip amputations. Handchir Mikrochir Plast Chir, 2023, 55(1): 28-34.
10. Van Handel AC, Pet MA. Fingertip replantation: technique details and review of the evidence. Hand Clin, 2021, 37(1): 53-65.
11. Thomson CH, Shah AK, Köhler G, et al. Mid-palm hand amputation: reconstruction of the superficial palmar arch. J Plast Reconstr Aesthet Surg, 2013, 66(8): 1155-1157.
12. 吴晋宝, 秦月琴, 程心恒, 等. 足背静脉的分布. 解剖学报, 1983, 14(3): 242-248.
13. 吴信举, 汤浩, 谢久虎, 等. 血管移植桥接在手指关节部位断指再植中的应用. 实用手外科杂志, 2021, 35(4): 436-438.
14. Krishnakumar KS, Petkar K, Lateef S, et al. Palmar arch reconstruction using dorsal venous arch of foot for revascularisation of multiple digits. Indian J Plast Surg, 2014, 47(1): 120-123.
15. 于胜军, 马振杰, 李晓, 等. 足背外侧静脉网移植修复手掌浅弓缺损八例. 中华显微外科杂志, 2022, 45(6): 629-633.
16. 赵强, 巨积辉, 李雷, 等. 移植自体浅静脉网桥接修复手部掌深浅弓损伤. 实用手外科杂志, 2008, 22(3): 167-168.
17. 刘良燚, 杨延军, 王克列, 等. 前臂掌侧浅静脉网的解剖学特点和临床应用. 中华显微外科杂志, 2011, 34(5): 420-421.
18. 于胜军, 孙明, 李京宁, 等. 带旋股外动脉内侧降支股前外侧皮瓣在毁损性断掌再植中的应用. 中华显微外科杂志, 2005, 28(1): 65-66.
19. 葛健君, 叶锋, 兰行远, 等. 使用自体血管移植修复失功自体动静脉内瘘的临床疗效分析. 中外医疗, 2022, 41(29): 5-9.
20. Del Piñal F. An update on the management of severe crush injury to the forearm and hand. Clin Plast Surg, 2020, 47(4): 461-489.

Chinese Journal of Reparative and Reconstructive Surgery

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