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Microsurgical replacement offers the best results for amputated fingers in adults.
Composite graft replacement of digital tips in children (ie, simple reattachment of the severed digit) is a common practice. For adults, microsurgical replantation or flap techniques such as Foucher "reposition flaps"1 are typically preferred given the high failure rate attributed to simple replacement. This article reports a series of 19 fingertip replacements performed from 1997 to 2003 in adults.
MATERIALS AND METHODS
Selection criteria were as follows:
* Microsurgical anastomosis was very risky or impossible either because it was a crush injury mechanism or because the amputation was very oblique.
* The patient could be operated on within four hours from the injury.
* The amputation was a level I or II (Ishikawa's classification),2 or up to level ?? in very oblique amputations.
* The pulp of the severed fingertip was reasonably preserved.
* Patients were aged <60 years.
There were seven women and 12 men. Mean patient age was 39.7 years (range: 25-58 years).
There were three crush transverse, three oblique crush, eight sharp oblique, and five crush oblique amputations.
Ishikawa et al2 defined four levels for distal amputations: level I for all amputations beyond the mid-nail level, level ? for amputations between the mid-nail bed level and the eponychium, level DI from the eponychium to the joint, and level IV, the joint area.
There were eight level I, seven level D, and four level ILT amputations. All level DI were very oblique sharp amputations.
SURGICAL TECHNIQUE
After minimal debridement, bleeding must be stopped completely to lower the risk of hematoma, which is always lethal to tip survival. Bleeding should be stopped by pressure only. If the pulp is bulky, it is defatted. The composite graft then is accurately replaced with absorbable skin sutures. Nail bed laceration is carefully reapproximated with 7-0 absorbable sutures. The nail then is replaced as a splint...