From April 2006, we have performed lymphaticovenous anastomosis (LVA) using indocyanine green fluorescence lymphography, and found that the untied stay suture method (USSM) is effective for vessels with diameters of 0.3-0.5mm or below. We applied the USSM for replantation of infantile zone 1 after fingertip amputation and obtained good results. Here we report this technique.
Two patients who underwent replantation of zone 1 after complete fingertip amputation using the USSM from August 2007 were studied. The USSM used for anastomosis of blood microvessels 0.3-0.5mm or less in diameter in fingertip replantation differed from that used in LVA. The 1^st and 2^nd stay sutures were placed but untied, and then the 3^rd and 4^th sutures were placed and tied, followed by tying of the two stay sutures. Both of the replanted fingertips survived, and good fingertip shape and good nail regrowth were obtained.
The USSM of placing the 1^st stay suture untied, then placing the 2^nd stay suture, and thereafter tying both stay sutures is especially effective for LVA with diameters of 0.3-0.5mm or below, in which the lymphatic wall is thin and transparent lymph flow into the vein. However, for anastomosis of blood microvessels 0.3-0.5mm in diameter or less, as in replantation of amputated fingertips, the method in which the 1^st and 2^nd stay sutures remain untied until after the 3^rd and 4^th (5^th, 6^th) sutures are placed and tied is an easier technique.