Fingertip replantation: Technical considerations and outcome analysis of 24 consecutive fingertip replantations (original) (raw)
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The Journal of Hand Surgery, 2006
To compare the functional outcome of successful microsurgical replantation versus amputation closure for single fingertip amputations. Methods: Forty-six fingertip amputations in 46 patients (23 were replanted successfully, 23 had amputation closure) were included in this study. Thumb amputations were excluded. Grip strength and active range of motion of the proximal interphalangeal joint were evaluated. The patients were questioned about their symptoms of pain, paresthesia, and cold intolerance. The Disabilities of the Arm, Shoulder, and Hand questionnaire was given and the disability/symptom score was evaluated. Patients' satisfaction with the surgical result was assessed. Time spent in the hospital and time off from work were reviewed. Results: Active range of motion of the proximal interphalangeal joint was greater in the successful replantation group. Although the existence of paresthesia and cold intolerance were not statistically different between the 2 groups, pain in the affected fingers was more frequent in the amputation closure group. The average Disabilities of the Arm, Shoulder, and Hand score of the successful replantation group was statistically better. All patients in the successful replantation group were highly or fairly satisfied with the surgical results, whereas 14 patients in the amputation closure group were highly or fairly satisfied. The time spent in the hospital and the time off from work for the successful replantation group were longer. Conclusions: Successful replantation of single fingertip amputations can result in minimal pain, better functional outcome, better appearance, and higher patient satisfaction. We recommend attempting fingertip replantation not only to obtain the best appearance but also to gain better functional outcome. If the patient requests the simple surgery and earlier return to work amputation closure is an accepted method despite the disadvantage of digital shortening and the risk for a painful stump. (J Hand Surg 2006;31A:811-818.
The Journal of Hand Surgery, 2007
Fingertip replantation is now an established technique. Although successful replantation is an ideal method for treatment of fingertip amputation, various other methods still are widely used and may be functionally acceptable. The indications for replantation to treat fingertip amputation is still controversial. This article presents a global view of the current status of replantation for the treatment of fingertip amputation. The surgical technique, strategies to overcome postoperative congestion, and overall results are discussed.
Finger Replantation in Sanglah General Hospital: Report of Five Cases and Literature Review
Bali Medical Journal, 2016
Background: Replantation is the prime treatment for amputated hands and fingers due to functional and aesthetic advantages. The absolute indications for replantation are amputations of the thumb, multiple fingers, trans metacarpal or hand, and any upper extremity in a child, regardless of the amputation level. A fingertip amputation distal to the insertion of the flexor digitorum superficialis (FDS) is also a good indication. Indications have been expanded to include amputation at nail level, and when there is a request from the patient, replantation is attempted even for a single finger amputation regardless of the amputation level. Based on the mechanism of injury, a clean-cut sharp amputation is more likely replanted compare to a crush and avulsion injuries. With a proper management of the amputated finger, replantation can be attempted even after 24 hours. This report was written to provide examples of finger replantation cases and the measures that can be taken in a resource-limited hospital in order to conduct a replantation. Case Series: We reported five out of nine digital replantation cases in Sanglah General Hospital between January and July 2014. Two patients were a six and an eleven years old boys who accidentally cut their finger while playing, the rests were male labors between 20-30 years old whose amputations due to machine injuries. Result: A 100% replant survival was achieved. After a period of follow up with occupational therapy, all patients regain good functional and cosmetic results.
Late results of replantations in tip amputations of the thumb
Acta Orthopaedica et Traumatologica Turcica, 2008
Amaç: Başparmak Tamai tip 1 amputasyonlarda uygulanan replantasyonlar geriye dönük olarak değerlendirildi. Çalışma planı: Çalışmaya, başparmak tırnak yatağı distalinde meydana gelen Tamai tip 1 amputasyonlar nedeniyle replantasyon uygulanan ve tedavi sonrasında dolaşım devamı sağlanan 14 hasta (12 erkek, 2 kadın; ort. yaş 28; dağılım 14-40) alındı. Tüm hastalarda santral digital arter anastomozu yapıldı. Anastomoza uygun ven bulunabilen dört hastada birer adet volar ven anastomozu yapıldı. Sinir tamiri sadece üç hastada yapılabildi. Duyu değerlendirmesi Semmes-Weinstein testi, iki nokta ayrım testi, hareketli iki nokta ayrım testi ve vibrasyon testi ile yapıldı; ayrıca, hastalar parmak atrofisi, soğuk intoleransı ve tırnak yatağı deformiteleri açısından incelendi. Ortalama takip süresi 11 ay (dağılım 6-48) idi. Sonuçlar: Semmes-Weinstein testi beş parmakta (%35.7) yeşil (dağılım 2.83-3.22), sekiz parmakta (%57.1) mavi (dağılım 3.22-3.61), bir parmakta (%7.1) mor (dağılım 3.84-4.31) idi. İki nokta ayrım testi ortalama skoru 6.9 mm (dağılım 3-11 mm), hareketli iki nokta ayrım testi ortalama skoru 4.5 mm (dağılım 3-6 mm) bulundu. Aynı elin sağlıklı parmaklarıyla karşılaştırıldığında, vibrasyon altı başparmakta (%42.9) artmış, altı başparmakta azalmış bulunurken, iki başparmağın (%14.3) vibrasyonu diğer parmaklarla eşit idi. Beş parmağın (%35.7) replante edilen kısmında atrofi; üçer hastada (%21.4) ise soğuk intoleransı ve tırnak deformitesi görüldü. Hastaların işe dönüş süreleri ortalaması 3.2 aydı (dağılım 2-6 ay). Çıkarımlar: Başparmak distal uç replantasyonları, teknik zorluklara rağmen, görünüm açısından ve fonksiyonel açıdan iyi sonuçlar vermektedir. Sinir tamiri yapılamayan olgularda da yeterli duysal iyileşme sağlanmaktadır.
Fingertip Injuries and Amputations: A Review of the Literature
Cureus, 2020
The fingertip is defined as the part of the digit distal to the insertion of the extensor and flexor tendons on the distal phalanx. Devastating injuries to the hand occur every year that lead fingertip amputations in thousands of people. The highest incidence rates are usually seen in children less than five years old and in adults over the age of 65. There are various presentations of injury that may end up with post-traumatic fingertip amputation, including lacerations, avulsions, and crush injuries. The fingertip is vital for sensation, as it has a high concentration of sensory receptors, and hence the restoration of sensation is the most important focus of treatment. The three main goals of treatment are the restoration of sensation and durability in the tip and assuring proper bone support to allow for nail growth. Many complications can arise after fingertip amputation, including delayed wound healing, nail deformities with poor aesthetics, hypersensitivity, residual pain, cold intolerance, scar retraction, flexion contractures, chronic ulceration, infection, and flap loss. The objective of this study is to provide an overview of the anatomy of the fingertip, the presentation of fingertip injuries and their management, and complications that might arise after surgery.
Open treatment of fingertip amputations
Annals of Emergency Medicine, 1983
of Fingertip Amputations Twenty-five patients with fingertip injuries at or distal to the distal interphalangeal joint were treated with a thorough cleansing of the wound with application of bacitracin and a sterile dressing. Warm soaks were begun 48 hours after injury. Crush injury was the most common type of trauma, followed by cutting injuries. Bone involvement was present in six cases. The average healing time was 29 days. At the time of complete healing, sensation was normal in 22 patients (88%). Systemic antibiotics were not administered routinely. No patient developed a wound infection. Our study documents that fingertip amputations can be successfully treated by nonoperative methods that result in preservation of finger length and contour, retention of sensation, and healing without infection.
Ulusal travma ve acil cerrahi dergisi = Turkish journal of trauma & emergency surgery : TJTES, 2018
Replantation is the gold standard procedure for traumatic amputation of fingertips. Reposition flap procedure is performed using nail-bone complex as a free graft and covering graft site with a flap to preserve original finger length, nail complex, and sensory functions of fingertip in pateints where microsurgical methods cannot be applied. In our study, we aimed to compare the long-term outcomes of patients with amputated fingertips who underwent replantation or reposition flap procedures. Thirty-five patients of replantation and 28 patients of reposition flap procedures only for 2nd, 3rd, and 4th fingertip amputations were included in the study. Complete fingertip amputations involved Foucher zones 2 and 3. The patients were followed up postoperatively for a median period of 13 months (9-23 months). All patients were assessed with static and dynamic 2-point discrimination tests, Semmes-Weinstein monofilament test, and cold intolerance test for the development of neuroma on the don...
A COMPARISON OF REPLANTATION AND TERMINALIZATION AFTER DISTAL FINGER AMPUTATION
This study records the subjective opinion of 30 patients who sustained a distal amputation of a single finger beyond the FDS tendon insertion which was treated by replantation, successfully or unsuccessfully, or by terminalization. All other patients who underwent replantation or terminalization of a single distal finger amputation but also had other injuries of the hand or fingers were excluded. Eleven patients had successful replantation, nine in whom replantation was not possible or was not successfnl had subsequent terminalization and ten had primary terminalization without attempting replantation. Only seven of the patients undergoing terminalization had further shortening of bone, the remainder being treated with homodigital neurovascular advancement flaps. Replantation was favoured by patients for sensory and motor functional reasons as well as for cosmetic reasons. Cold intolerance was less common in the successfully replanted fingers.