A composite approach for Tamai zone I fingertip replantation in the absence of suitable veins: a case report

Fingertip amputation at Tamai Zone I remains technically challenging due to extremely small vessel size and the frequent absence of suitable veins for venous anastomosis. Venous congestion is a major cause of failure, and various strategies have been proposed to address limited venous outflow. We report a 28-year-old man with a complete Tamai Zone I amputation of the left index fingertip following a motorcycle chain injury. Replantation was completed approximately 8 h after injury. As no suitable vein for conventional venous anastomosis, a composite microsurgical strategy was implemented, integrating multiple coordinated components: arterial repair, direct arteriovenous (AV) anastomosis, controlled ligation of the distal palmar arterial arch, nail plate removal, and short-term postoperative anticoagulation. At one-year follow-up, the replanted fingertip survived completely with satisfactory aesthetic and functional outcomes. The nail regrew with minimal deformity, the distal interphalangeal joint regained full range of motion, and sensory recovery was satisfactory with a two-point discrimination of 7 mm. This case demonstrates the feasibility of a composite microsurgical approach for Tamai Zone I fingertip replantation in the absence of suitable veins. However, given the combined nature of the interventions, the relative contribution of each component cannot be determined, and further studies are required to validate this strategy.