A comparative study of lateral and palmar venous anastomosis in Ishikawa zone Ⅱ fingertip replantation.

Purpose: Venous anastomosis is the key procedure for Ishikawa zone II fingertip replantation. Both palmar and lateral veins provide efficient venous drainage. This study compared the clinical effects between these venous anastomoses for fingertip replantation. Methods: In 2016-2018, 61 patients underwent Ishikawa zone II fingertip replantation with venous anastomosis (28 and 33 cases with palmar and lateral anastomoses, respectively). Retrospective comparative analyses evaluated surgical technique and function, including operative time; rates of finger survival, venous congestion, and infection; sensation; joint motion; cold intolerance symptom severity (CISS), Disabilities of the Arm, Shoulder, and Hand (DASH), and Vancouver scar scores; and chronic regional pain syndrome (CRPS) rates. Results: There were 33 patients with lateral vein anastomosis and 28 patients with palmar vein anastomosis. The average patient follow-up was 18.2 months. The survival rates did not differ significantly between groups (87.8% (29/33) vs. 85.7% (24/28),p> 0.05); however, the operative time was shorter in the lateral vein group than in the palmar vein group (78.57 +/- 7.08 min vs. 67.88 +/- 5.77 min,p< 0.05). Venous congestion and infection rates did not differ significantly between groups (p> 0.05). The replanted finger function, including joint motion, sensation, DASH scores, Vancouver scar scores, and CRPS rates, did not differ significantly between groups (p> 0.05). However, the CISS score was higher in the palmar vein group than in the lateral vein group (44.39 +/- 5.16 vs. 38.09 +/- 4.49,p< 0.05). Conclusions: Venous anastomosis with either palmar or lateral veins showed high survival rates and good function in fingertip replantation. The lateral vein had a shorter operative time and benefit to arterial revision and was especially suitable for patients with finger pulp damage.