Abstract
From January 2005 to December 2008, we treated 59 patients with a total of 67 complete fingertip amputations. By statistically analyzing these 67 cases, we reported that up to subzone III (Ishikawa’s subzone), replanted fingertips could survive with arterial anastomosis alone, and we established a new treatment strategy. 1. For cases with amputation levels subzones I to III, arterial anastomosis was performed under digital block and venous anastomosis if possible. If the venous anastomosis was not performed, care was taken to relieve postoperative congestion. General anesthesia was used in cases where the patient had difficulty in staying still, such as a child. 2. For cases with amputation levels more proximal than subzone IV, both arterial and venous anastomoses were performed. Venous anastomosis is essential and considering the possibility of a vein graft, operations were performed either under axillary block or general anesthesia. From July 2012 to November 2014, we treated 21 patients with 22 fingertip amputations according to the new treatment plan. Results: Amputation levels were as follows: subzone I, 10 fingers; subzone II, 7 fingers; subzone III, 1 finger; and subzone IV, 4 fingers. Overall replantation success rate was 95% (21 out of 22 fingers). Conclusion: For the past two years, we have established a new treatment strategy for complete fingertip amputations, and obtained favorable outcomes. Depending on the situation of the patients and institutions, this strategy could become one of the treatment options.
Highlights
Among finger amputations, fingertip amputations when replanted successfully provide excellent esthetic and functional results with high patient satisfaction [1]
There were few sufficient data regarding at which level a replanted fingertip can survive solely on arterial anastomosis
We performed a statistical review of our clinical data, and reported that up to subzone III (Ishikawa’s subzone), there is a high possibility of replanted fingertips surviving with arterial anastomosis alone [2]
Summary
Fingertip amputations when replanted successfully provide excellent esthetic and functional results with high patient satisfaction [1]. We performed a statistical review of our clinical data, and reported that up to subzone III (Ishikawa’s subzone), there is a high possibility of replanted fingertips surviving with arterial anastomosis alone [2]. Based on this result, we have established and acted upon a new treatment strategy, and hereby report the favorable outcomes. There have reports that in amputations distal from the DIP joint, sensory recovery is fairly well without nerve repair, so no attempt in nerve repair was made in any cases [3]
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