II. Indications: Fingertip Amputation
- Dorsal Plane Zone II Fingertip Amputation
- More finger nail avulsed than pulp
- Transverse Plane Zone II Fingertip Amputation
- Equivalent amounts of finger nail avulsed as pulp
III. Contraindications
- Volar Plane Zone II Fingertip Amputation
- More fingertip pulp avulsed than finger nail
IV. Efficacy
- Preserves finger tip padding and contour
- Most patients re-establish Two Point Discrimination
- Good cosmetic result with minimal scar
V. Technique: Step 1 Preparation
- Anesthesia with Digital Block
- Elevate hand above heart level to drain blood
- Apply Tourniquet (Rubber band or penrose drain)
- Provide adequate Wound Irrigation and debride
- Trim protruding distal phalanx with rongeur
VI. Technique: Step 2 Create Triangular Flap
- Make V incision on pulp side of amputation
- Base of triangle is at cut edge of amputation
- Width of triangle base is as wide as amputation
- Apex of triangle is centered above DIP crease
- Incision depth includes full skin thickness
- Do not undermine skin edges (destroys blood supply)
VII. Technique: Step 3 Suture Flap
- Advance flap to cover amputation defect
- Suture flap to nail bed using 5-0 or 6-0 Nylon Suture
- Anchor each triangle point with Corner Stitches
- Extend apex of triangle to create Y-shaped wound
- Reattach all skin edges with simple Sutures
VIII. Technique: Step 4 Assess Return to Blood Flow
- Remove Tourniquet
- Observe return to Blood Flow
- Expect delayed Capillary Refill in first 5-10 minutes
- Persistant delayed refill suggests devascularization
- Check distal Sutures for too snug closure
IX. Technique: Step 5 Complete Procedure
- Antiobiotic ointment for moist Wound Healing
- Apply dressing
- Consider Splinting