A rare case of finger ischemia following bypass procedure with autologous vein graft for thumb revascularization: a case report and brief review of the literature
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This case report aims to point out the importance of having in mind anatomical variation in the blood supply to the hand even in emergency settings. A 39-year-old patient presented at our emergency department with a wound on the distal anterolateral third of the left forearm with skin loss, degloving injury of the thumb starting from the 1st metacarpal, exposure of the proximal two thirds of the 1st metacarpal bone, and both radial and ulnar digital arteries of the thumb damaged. A 10-cm-long vein graft was anastomosed in termino-later fashion between the dorsal branch of the radial artery and the uninjured distal part of the ulnar collateral digital artery of the thumb, successfully re-establishing its blood supply. Starting from the 1st postoperative day, the thumb was warm and pink while the other fingers were pale and capillary filling was absent. An urgent arteriography of the left upper extremity demonstrated the presence of normal radial artery, hypoplastic ulnar artery, dominant median artery, and absence of vascularization of the 2nd, 3rd, 4th, and 5th fingers. By the end of 2nd week, the patient underwent amputation of the four fingers at the distal metacarpal level. Anatomical anomalies of hand arterial blood supply are not uncommon, even though rarely reported in literature. Therefore, an instrumental study should be performed before attempting any arterial intervention even in emergency settings. Nevertheless, further studies should be performed to identify ready-to-use tools to make surgeons aware of any anatomic variations in order to avoid such complications.
Level of Evidence: Level V, therapeutic study.
KeywordsHand surgery Microsurgery Thumb replantation Surgical complication Ultrasound
Authors would like to thank Marisa Mancini (O.U. of Hand Surgery and Microsurgery; Azienda Ospedaliero-Universitaria of Modena), medical and photograph illustrator, for her help in the making of the illustrations.
Compliance with ethical standards
This study did not receive any funding.
Conflict of interest
Norman Della Rosa, Nicolò Bertozzi, Giulia Colzani, and Roberto Adani declare that they have no conflict of interest.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Furthermore for this type of study formal consent is not required.
Informed consent was obtained from all individual participants included in the study.
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