Fingertip Amputation Repair

1. See Also
   1. Fingertip Amputation
2. Indications: Fingertip Amputation
   1. Dorsal Plane Zone II Fingertip Amputation
      1. More finger nail avulsed than pulp
   2. Transverse Plane Zone II Fingertip Amputation
      1. Equivalent amounts of finger nail avulsed as pulp
3. Contraindications
   1. Volar Plane Zone II Fingertip Amputation
      1. More fingertip pulp avulsed than finger nail
4. Efficacy
   1. Preserves finger tip padding and contour
   2. Most patients re-establish Two Point Discrimination
   3. Good cosmetic result with minimal scar
5. Technique: Step 1 Preparation
   1. Anesthesia with Digital Block
   2. Elevate hand above heart level to drain blood
   3. Apply Tourniquet (Rubber band or penrose drain)
   4. Provide adequate wound irrigation and debride
   5. Trim protruding distal phalanx with rongeur
6. Technique: Step 2 Create Triangular Flap
   1. Make V incision on pulp side of amputation
      1. Base of triangle is at cut edge of amputation
      2. Width of triangle base is as wide as amputation
      3. Apex of triangle is centered above DIP crease
   2. Incision depth includes full skin thickness
      1. Do not undermine skin edges (destroys blood supply)
7. Technique: Step 3 Suture Flap
   1. Advance flap to cover amputation defect
   2. Suture flap to nail bed using 5-0 or 6-0 Nylon Suture
   3. Anchor each triangle point with Corner Stitches
   4. Extend apex of triangle to create Y-shaped wound
   5. Reattach all skin edges with simple Sutures
8. Technique: Step 4 Assess Return to Blood Flow
   1. Remove Tourniquet
   2. Observe return to blood flow
      1. Expect delayed Capillary Refill in first 5-10 minutes
      2. Persistant delayed refill suggests devascularization
      3. Check distal Sutures for too snug closure
9. Technique: Step 5 Complete Procedure
   1. Antiobiotic ointment for moist Wound Healing
   2. Apply dressing
   3. Consider Splinting
10. References
    1. Jackson (2001) Am Fam Physician 64(3):455-8 [PubMed]
    2. Martin (1998) Clin Orthop 353:63-73 [PubMed]
    3. Rosenthal (1983) Orthop Clin North Am 14:675-97 [PubMed]