Free tissue transfer has become the method of choice for the reconstruction of fingers. The identification of recipient veins is one of the most important points to consider for successful finger replantation and free flap reconstruction of fingers, including toe-to-finger transfer, hemipulp flap transfer, and digital artery perforator flap transfer.1 However, this identification is challenging, especially in cases with severe injury. Although ultrasonography enables us to identify recipient veins, it is difficult to identify them without flow. Furthermore, ultrasonography is inconvenient for bedside examinations and marking the recipient veins. To address these challenges, we used a light-emitting diode (LED) transilluminator to identify recipient veins in finger reconstruction.
Reconstruction of the finger using a super-thin superficial circumflex iliac perforator flap after injury was planned.2 Using an LED transilluminator (MK-02GX; ESU LLP, Japan), recipient veins in the fingers were visualized preoperatively [Fig. 1; see figure, Supplemental Digital Content 1, which displays reconstruction of the finger after injury was organized (a and b). Using a light-emitting diode (LED) transilluminator (MK-02GX, ESU LLP, Japan), recipient veins in fingers were visualized preoperatively (c and d), https://links.lww.com/PRSGO/A615]. The LED transilluminator consists of an 84 × 53 × 25 mm3 main body and a light-emitting part (Fig. 2). This transilluminator enables us to observe the superficial veins of the fingers and hands through the transmission of LED light. An examiner can easily control the light-emitting probe of an LED transilluminator with one hand while marking the identified recipient veins with the other hand.
A preoperative examination using an LED transilluminator has 3 main advantages. First, not only the recipient veins in the fingers but also the superficial donor veins of hemipulp flaps, second toe flaps, and wrap-around flaps, among others, can be identified through the transemission of LED light. Second, because the recipient site is illuminated from beneath using one hand, it is quite easy for an examiner to mark the identified vessels. Third, the LED transilluminator is small in size and light in weight (71.8 g) and can be used anywhere and anytime.
Although further clinical investigations will be required to confirm its efficacy, the LED transilluminator has the potential to be a useful instrument for the identification of recipient veins in finger reconstruction.
1. Yoshimatsu H, Iida T, Hayashi A, et al. Free lateral digital flap for reconstruction of the fingers. Ann Plast Surg. 2017;79:477–481.
2. Narushima M, Iida T, Kaji N, et al. Superficial circumflex iliac artery pure skin perforator-based superthin flap for hand and finger reconstruction. J Plast Reconstr Aesthet Surg. 2016;69:827–834.