A novel solution for venous congestion following digital replantation: a proximally based cross-finger flap

Digital replantations are often complicated by problems of venous congestion. Conservative management is not always successful. Furthermore, the skin edge around the replanted digit is frequently inflamed and necrotic, leading to difficulties in restoring venous flow by direct venous anastomosis or interpositional vein grafts. We introduce a novel solution using the proximally based cross-finger flap. We used this flap in 10 patients who had venous congestion with inflamed, necrotic skin at their digital replant site. Their initial injuries were amputation injuries. The flap had an average length of 3.98 cm and width of 2.59 cm and was harvested from the dorsum of the adjacent, uninjured digit. There was only 1 failure, due to massive crush injury. Of the remaining 9 cases, 7 met or exceeded the sensory threshold (Semmes-Weinstein monofilament test). The 2-point discrimination test was less than 6 mm in 8 cases. Three patients complained of residual pain (based on the Michigan Hand Outcomes Questionnaire), and only 1 was unsatisfied with the appearance. The proximally based cross-finger flap is pedicled and requires only a single level of venous anastomosis distally, leading to a higher success rate. It offers a simple yet effective solution for venous congestion.