Personal Experience of Replantation for Tamai Zone I Fingertip Amputation

Abstract

Fingertip amputations in Changhua usually take place because of the intensive distribution of local machinery plants in that area. Though replantation of the fingertip is not a routine procedure because of the cost in operative time and energy to achieve success, the advantages of improved function, nail salvage, elimination of the need for donor sites for later reconstruction and the patient's willingness to maintain bodily integrity meant it has been almost the first choice procedure of our patients in middle Taiwan. 24 Tamai zone I fingertip replantations (amputation at or near lunula) of 22 patients were performed by a single surgeon at Show Chuan Memorial Hospital from December 2002 to October 2004. There were 13 male and 9 female patients, ages ranging from 21 to 59 with an average of 37 years. 18 patients underwent complete amputation and 4 patients had an incomplete amputation without vascular tissue connection. The cases of composite graft were excluded. The type of injury for all patients was crush injury. All patients received microvascular surgery. Artery-only anatomizes with external bleeding via fish mouth incision over the fingertip were performed on 16 digits, and venous drainage was created in the other 8 digits. The replantations were completed under standard microsurgery procedures except for the nerve coaptation and tendon repair. The usual adjuvant medication such as volume expander and anti-thrombin agents were administered for at least 5 days following surgery. Of the 24 digits, 13 digits achieved complete survival, 3 digits partially survived and 8 digits failed to survive. The overall survival rate of the crush injury patients was 66.6%. In successful follow-up cases, all had satisfactory nail regeneration and appearance except one flexion deformity of DIP joint and one nail deviation. The mean DIP flexion was 35.7° and average static two point discrimination was 10.6mm; only one patient experienced cold intolerance. Microsurgical replantation is the only one stage procedure to preserve nails with minor donor site morbidity, especially in crush cases. In this article, we will review the literature and share personal experiences. (J Plast Surg Asso R.O.C. 2006; 15:229~240)