Functional and Aesthetic Evaluation of Expanded Applications of Conservative Management of Fingertip Amputations

Abstract

Background: Fingertip amputations are the most commontype of amputation injury in the upper extremity. Treatmentsavailable cover a broad range of techniques, surgical andconservative. Although there is no consensus on how theseinjuries should be treated, the goals of treatment should includeminimization of pain, optimization of healing time, preservationof sensibility and length, prevention of painful neuromas,avoidance or limiting of nail deformity, minimization of timelost from work, and provision of an acceptable cosmeticappearance.Patients and Methods: We have prospectively studied 20patients with fingertip amputations of all ages. Daily simplenon adherent non occlusive dressing, paraffin-impregnatedgause, with an ointment initially for debridement then forhealing was used. We used pinch gauge, finger goniometer,caliper and compass to measure pinch tip strength, distalphalanx range of motion and 2 point discrimination distance,respectively.Results: The mean age was (33±17.3) years old. The meanhealing time was (36.4±5.8) days and mean time off workwas (11.6±7.6) days. As regards sensibility 30% complainnumbness, 35% had hyper-sensibility, and 35% show normalsensibility. As regards two point discrimination in the correspondinghealthy fingertip, the mean distance was (4.7±1.5)mm, versus (8.6±2.5) mm in amputated fingertip. There wasno tenderness, cold intolerance, joint stiffness, neuroma ordisability. 50% expressed good aesthetic results, 40% ofpatients were accepted, and 10% had poor aesthetic results.Conclusion: The functional outcome was good, as therewere no tenderness, cold intolerance, joint stiffness, neuromaor disability. Although, longer healing time, time off workwas generally acceptable. Irrespective of that a 35% of patientshave hyper-sensibility and 30% complained of numbness,there were no significant bad impact on the function and earlyreturn to work. Aesthetically, hook nail deformity was theonly cause of poor aesthetic results. However, conservativemanagement of fingertip amputations using simple dailydressing changes, provides good and acceptable results outweighsthe poor results.