Transfer of vessels in the management of thumb and ring avulsion injuries

Abstract

The main problem in avulsion or degloving injury is the extensive damage to long segments of vessels which makes direct suture of the structures difficult. Various techniques have been proposed over the years to bypass the segment of an injured vessel. Many of these are difficult and often require the execution of several vascular anastomoses. The transfer of vessels from adjacent fingers, as proposed by Doi, is a valid alternative. During the 5-year period from 1988 to 1993, vessel transfer from adjacent fingers was carried out on 15 patients. Three patients suffered incomplete amputation and 5 patients suffered complete amputation of the thumb. In 5 cases these were severe crush injuries and in 3 cases they were avulsion injuries. Seven patients suffered ring avulsion injuries of various degrees. The simplicity and reliability of the method (one case was unsuccessful) make this an important technique in the treatment of crush and avulsion injuries of the thumb as well as of ring avulsion injuries.