ArticleJournal of orthopaedic surgery and research2025
Two-stage replantation of a severed digit with blood supply from the first dorsal metatarsal artery.
Article in Journal of orthopaedic surgery and research, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
objectiveThe aim of this study is to examine the feasibility and clinical outcomes of a two-stage digit reconstruction technique involving initial ectopic implantation followed by secondary replantation in cases where direct in situ replantation of severed digits is not possible. The technique employes the first dorsal metatarsal artery as the source of vascular supply.
methodsA retrospective review was performed on 13 patients (8 males, 5 females; age range: 7-61 years; mean age: 38 ± 14.4 years) who sustained crush-avulsion injuries of the fingers and underwent treatment between December 2009 and December 2023. The intact amputated digits were temporarily transplanted to the dorsum of the foot, where blood supply was maintained via the first dorsal metatarsal artery. After a period of 1 to 4 months, during which graft survival was ensured, secondary replantation was conducted for reconstruction of the affected digits. Postoperative monitoring included assessments of vascular perfusion and evaluation of sensory and motor functions of the reconstructed digits. Functional recovery was assessed based on the criteria set forth by the Chinese Society of Hand Surgery.
resultsAll 13 patients met the criteria for temporary ectopic implantation. The temporarily transplanted digits included 7 thumbs, 2 index fingers, 3 middle fingers, and 1 ring finger, all of which survived the initial implantation. During the second-stage reconstruction, a total of 13 fingers were successfully replanted, including 10 thumbs, 1 index finger, 1 middle finger, and 1 ring finger. Follow-up durations ranged from 1 to 12 years (mean: 4.2 years). Functional outcomes were categorized as excellent in 2 cases, good in 8 cases, and fair in 3 cases; no poor outcomes were reported.
conclusionThe dorsum of the foot provides a viable and effective site for one-stage ectopic replantation of severed digits when in situ replantation is not feasible. Utilization of the first dorsal metatarsal artery as a vascular source for digit reconstruction demonstrates both procedural safety and favorable clinical outcomes.
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