| OBJECTIVEThe part distal to the finger nail root is defined as the fingertip.lt is a special zone for replantation ,My aim is to found the distribute route of fingertip blood vessel by microanatomy. According to the route ,how to finish fingertip replantation better is another aim.METHODS30 fingertips were studied under the microscope in fresh cadavers by infusing methylene blue in the arteries .The result showed that the vessels were terminal ramifications and had obvious patterns..568 fingertips were replanted in 452 cases with 542 which survived.(95.4%)2.2OPERATIVEMETHEDOperating method: Replantation of the fingertips was simpler than digital replantaion..Using a reverse method of replantation ,even excising a segment of the vessel would not increase the tension of the anastomosed vessel. The order of replantation was: palmar skin-subcutaneous veins-artery-digital nerves-fixation of bone and then wound closure. Thorough debridement was the key to successful operation. Debridement should be done under the microscope so that the tissue could be identified easily.2By cutting the skin edge with a fine scalpel the subcutaneous veins could be found.3 Subcutaneous tissue should be removed like rolling the carpet with scissors. Artery branch should be searched for carefully when arriving at the central part of insertion ofFDP(flexor digitorum profundus)tendon.While removing the exposed tissue in degloving injury, one should not cut the arterial branch.Shortening the phalangeal stump can be prevented by fixing with a syringe needle.After debridement,wash the tissue by l:2000Broma Geraminum solution for further sterilization.Generally ,digital artery was easily found but to find subcutaneous vein was difficult.RESULTSThe diameter of artery and distributive route of fmgertip:Five branches arise from the arterial arch .Two of the branches are situated on both sides of the insertion of the flexor digitorum profundus(FDP) tendon. They were 0.1-0.2mm in diameter. Three branches in the center were 0.2-0.3mm in diameter. Each of the five branches can be anastomosed . The starting point of the arterial branches was at the level of the lunula .The diameter of Vein and distributive route of fingertip The palmar veins were very thin ,of 0.1 -0.4mm in diameter. They were larger on the radial aspect of the little finger and the ulnar aspect of the other fingers .The veins proximal to the level of the midpoint of the nail could be anastomosed.The resultof replantation of fingertip ; There were 350 male patients and 102 females.Their ages ranged from 13 to 50 years(median 28.Syears).Their occupations:workers389;farmers63.The injury patterns included knife cut ,electric saw,crush.All the injured fingers were completely amputated.There were 144 thumbs, 208 indexes,85 long fingers,94 ring fingers,and 37 little fingers.568 fingertips were replanted in 452 cases with 542 which survived.(95.4%) The follow-up time was from 12 to 36 months. The peripheral microcirculation of the replanted tips was normal and the finger pulp grew well. There was good sensory recovery and two-point discrimination ranged from 3 to 5mm.The injured finger was not shortened during operation. Nail regenerated well with good cosmeticappearance. Patients in general were quite satisfied with the results. CONCLUSION4.1 The fingertip blood vessels anatomy showed mat the vessels were tenninal ramifications and had obvious patterns. Anastomosed palm vein could meet the need of vein circulation4.2According the distributive route of fingertip ,lt is easy to find the blood vessel during replantioa. Us benefit is shorting the operating time. Patients in general are quite satisfied with the results,4.3AmputatioD at this level is classified into six types according to microanatomy and clinical application: Such injuries of the fingertip are not uncommon in daily life,so correct treatment can reduce the damage of the finger.
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