Reconstruction of motorcycle spokes wheel injury fingertip amputations with reposition flap technique: a report of 40 cases

Abstract

Replantation of the distal fingertip amputation poses a technical challenge to the treating hand surgeon especially dealing with motorcycle spokes wheel injury causing Allen's type III and IV amputation. The reason being the pulp charred and severely crushed. Various reconstructive options have been described in the literature. We analyze the surgical option of repositioning the amputated stump with local pedicle flaps in such injuries and interpreting the results and functional outcome. Forty patients with motorcycle spokes wheel fingertip amputations involving thumb (60%) and index, middle, and ring fingers were operated by reposition flap between 2017 and 2019. Group I was Allen's type III amputations (n = 20). Group II was type IV amputations (n = 20). Range of movements, 2-point discrimination, sensation, intolerance to cold, nail aesthetics outcome, VAS, quick DASH score and return to work were analyzed in these two groups and evaluated. The average follow-up of our study in group I and group II was 24.6 and 24.4months, respectively. All patients returned to work in an average of 13.4weeks with a good radiological bone union and an excellent range of movements. All had an average 2-point discrimination of 8.5mm and 8.3mm; VAS as 0.2, mean quick DASH score 5.4 and 5.0, respectively in both groups. 15% dysplastic nail and 30% had cold intolerance; all had satisfactory sensation in the final follow-up with an average finger shortening of 4.7 and 5mm. No finger stiffness and donor site morbidity seen. Reposition of the amputated distal phalanx, free nailbed graft with cross finger flap in motorcycle spokes wheel injury is safe, and effective. It preserves the pulp contour and gives a good functional outcome. It is a viable alternative option to replantation in Allen's type III and IV fingertip amputations especially in motorcycle spokes wheel injury with pulp loss. IV.