HAND/PERIPHERAL NERVE Bridging the Gap in Hand Replantation: Use of the Common Digital Artery for Completion of the Superficial Palmar Arch Ron Hazani, M.D. Josh Elston, B.S. Darrell Brooks, M.D. Bradon J. Wilhelmi, M.D. Louisville, Ky.; and San Francisco, Calif. Background: Traumatic hand amputations along a longitudinal axis are pos- sible but, to the authors’ knowledge, have not been described in the literature. To bridge the gap and repair the transected superficial palmar arch at its apex, a common digital artery can be sacrificed and turned toward the plane of the arch. An anatomical study was performed to investigate the possibility of using the common digital artery to the third web space for completion of the super- ficial palmar arch. Methods: Fifteen fresh cadaveric hands were dissected to evaluate the caliber and origin of the common digital artery to the third web space for possible reconstitution of the arch. Results: In all specimens, a complete superficial palmar arch was identified. In 10 specimens, the superficial palmar arch caliber tapered off from the ulnar to the radial aspect, indicating an anatomical ulnar dominance of the arch. The average diameter of the common digital artery to the third web space was 1.7  0.2 mm. The average superficial palmar arch diameter measured 1.6  0.7 mm on the radial side of the common digital artery. In two female cadaver specimens, a unique pattern in the origin of the common digital artery was identified. The common digital artery to the second and third web spaces originated from a common branch off of the superficial palmar arch. Conclusions: Replantation of a longitudinally amputated hand can be per- formed based solely on a common digital artery for reconstitution of palmar arch flow. However, because of known variability in the palmar arch configu- ration, intraoperative clamping must be used to ensure safe use of the donor vessels while avoiding distal ischemic risk. (Plast. Reconstr. Surg. 126: 2037, 2010.) T he decision to proceed with replantation in the upper extremity depends on several fac- tors. These include the mechanism of injury and the patient’s age, occupation, and overall med- ical condition. When considering the level of injury, good functional outcome can be achieved after re- plantation of the digits distal to the insertion of the flexor pollicis superficialis, 1 or replantation of the hand at the wrist or distal radius level. 2 Traditionally, reports of hand or transmeta- carpal amputations relate to a certain type of in- jury pattern. These are along the transverse or oblique axis of the hand. Traumatic hand ampu- tations along a longitudinal axis are possible but, to our knowledge, have not been described in the literature. At the time of a longitudinal hand am- putation, the injured hand is used to stabilize a wooden beam as it passes through the saw in a longitudinal fashion. This unique pattern of injury can present as a challenge to the reconstructive surgeon. The su- perficial palmar arch is disrupted at its apex and along the superficial palmar branch of the radial or ulnar artery. Primary repair of the arch at the apex is difficult, as the origins of the common From the Division of Plastic Surgery, University of Louisville School of Medicine, and The Buncke Clinic. Received for publication March 24, 2010; accepted June 17, 2010. Presented at the 2010 Annual Meeting of the American Association of Hand Surgery, in Boca Raton, Florida, Jan- uary 6 through 9, 2010. Copyright ©2010 by the American Society of Plastic Surgeons DOI: 10.1097/PRS.0b013e3181f449e1 Disclosure: The authors have no financial interest to declare in relation to the content of this article. www.PRSJournal.com 2037