Pulp De-epithelialization for Venous Outflow Augmentation after Digital Replantation

• Authors: Erica Smearman, Emory University School of Medicine; Patricia Chan, Emory University School of Medicine; Paul Ghareeb, Emory University
• Journal Title: Plastic and Reconstructive Surgery - Global Open
• Volume: Volume 9, Number 12
• Publisher: Wolters Kluwer Health, Inc. | 2021-12-10, Pages e4016-e4016
• Type of Work: Article | Final Publisher PDF
• Publisher DOI: http://doi.org/10.1097/GOX.0000000000004016
• Subjects: Health Sciences, Medicine and Surgery; Biology, General

Abstract

Summary: Traumatic amputation injuries account for a substantial portion of emergency department visits. This includes digital amputations that may be considered for replantation. Following surgery, venous congestion is the most common cause of replant failure. To address this, several methods have been proposed to augment venous outflow. In this article, a simple and straightforward method that can be utilized to establish or augment venous outflow in cases of venous insufficiency is described. This method entails de-epithelization of the replanted digit pulp skin with use of postoperative anticoagulation. The area can be further expanded or stimulated to increase bleeding as needed and is allowed to heal by secondary intention. This method allows for reliable venous outflow with relative ease of implementation.