Thumb replantation using the reversed radial artery

into seven different types; type 7 (which occurs in 0.7%) has common palmar digital arteries only to the third and fourth interspaces. The region that should be supplied by an absent branch of the superficial arch may instead be supplied by a palmar metacarpal artery (Coleman and Anson, 1961). This type of arterial anomaly is consistent with that in case 1. Buck-Gramkco (1991) reported one case of complete necrosis of the transposed index finger in his series of 460 pollicization surgeries. He suggested that this was due to an arterial anomaly in which both arteries were supplied only by a short metacarpal artery. This arterial anomaly closely resembled that in our case 1. In case 2, the first common palmar digital artery penetrated the proper digital nerve of the middle finger. This anomaly is thought to involve a digital neural loop. This type of neural loop in the second interdigital space was found in 10 of 51 (20%) dissected specimens of the palm (Gotani and Gilbert, 1999). In patients with this anomaly, the index finger cannot be transposed proximally without microdissection of the ramus. Conflict of interests