Abstract

Crush injuries pose significant challenges for replantation due to extensive vascular and nerve damage. Vein grafts help overcome vascular defects in such cases, increasing the likelihood of successful revascularization. In this report, we present the case of a 14-year-old male who suffered subtotal amputations at the mid-metacarpal level due to a crush injury. Three fingers were revascularized using a single Psi (Ψ)-shaped vein graft with three branches, from the distal volar surface of the forearm. The ulnar artery was used for proximal anastomosis, and the graft's three branches were anastomosed to the common digital arteries. There were no circulatory problems; however, the patient's development of post-traumatic stress disorder in the postoperative period led to incomplete adherence to physiotherapy and resulted in suboptimal recovery. Vein grafts with multiple branches harvested from the distal forearm, such as the Psi (Ψ)-shaped graft, offer ease of harvesting and favorable size compatibility and may serve as a practical solution for complex vascular reconstructions in crush injuries at the transmetacarpal level.

Key words: replantation, vein graft, palmar arch, crush injury, post-traumatic stress disorder, forearm