Salvage of an avulsion amputated thumb at the interphalangeal joint level using afferent arteriovenous shunting

Abstract

Replantation of digits following avulsion amputation is a challenge due to the severity of damage to the digital vessels. When the digital vessels are absent or severely injured, standard artery-to-artery or vein-to-vein anastomoses may be impossible and arteriovenous shunting can be used as a salvage procedure for arterial inflow or venous drainage. Previous cases of successful replantation of avulsed digits that were reperfused using afferent arteriovenous shunting reported small segments of tissues only, usually at the level of the distal phalangeal joint or distal to it. Our case demonstrates that afferent arteriovenous shunting can also provide adequate perfusion to a large piece of tissue in the thumb even when the amputation level is at the interphalangeal joint.