Anatomical Observation And Clinical Application Of Carpometacarpal Superficial Vein In Complicated Digit(s) Replantation

Objectives: To study the anatomical characterstics of carpometacarpal superficial vein.To explore the clinical application and effects of carpometacarpal superficial vein through anatomical observation in complicated digital replantation and its clinical significance. Methods: The anatomical observation and hemodynamic study were performed in order to find out the position, gross morphology, number and size of valve of carpometacarpal superficial vein in 28 forearms in 14 cadavers.The exposure rate of carpometacarpal superficial vein was studied in 60 forearms in 30 healthy young group.The carpometacarpal superficial veins were grafted in 28 digits in 24 cases of severed injured vessels accompanied with vascular defects in complicated digital replantation and 6 digits in 6 cases of postoperative vascular insufficiency. Hemodynamic study was carried out in intraoperative incised vein and result thus obtained was compared with former anatomical observation.Results: Through anatomical observation, 1-3 comparatively constant superficial veins were found beneath the dermis in carpometacarpal region .The different size and diameter of main stem superficial vein and its tributaries were normally matched with proper palmar digital artery and dorsal digital vein in different phalanges of digits. The exposure rate of carpometacarpal superficial vein in cadavers and healthy young group were 100%. 29 arteries and 9 veins were repaired by autografting carpometacarpal superficial vein in 34 digits, 31 digits were survived, with 91.2% of survival rate which was significantly superior than non-vein grafting digital replanted group with 75%survival rate. The rate of vascular crisis in former group was 18%, significantly lower than the latter group (24%).Among which 23 digits in 21 cases were subjected to follow –up for 5M- 24M with 12 excellent, 8 good, 1 fair and 2 bad; the rate of excellent and good was 86.96% .Conclusions: The advantages of carpometacarpal superficial veins are as: superficially located, constant in number as well as exposure, convenient to draw material, possible to shorten operating time. The most important is that the different size and diameter of main stem vein and its tributaries can easily satisfy the demand of vein grafting in different phalanges of digits. Hence, it is a possible selective material to repair vessels defects in complicated digital replantation by vein autograft, thus known as "vessel bank".