gms | German Medical Science

Objectives/Interrogation: Fingertip amputations vary widely in mechanism, ranging from sharp lacerations to crush injuries that present with varying degrees of contamination and irregular skin loss. Injuries can be work or non-work related, and in either case rapid return to work without any dressing and rapid recovery of sensation in the fingertip is sought for by the injured. When bone is exposed with preservation of nail matrix a flap is required to restore the contact surface of the pulp. We report on the versatility of the neurovascular advancement flap (initially described by Venkatswami) especially in cases with irregular skin loss where conventional V-Y advancement flaps are tricky.

Methods: Prospective with retrospective study conducted in a large volume tertiary care center, where 22 fingers in 20 patients were studied. All patients had some part of nail bed preserved (Allen 3 and 4 types), but with varied obliquity and irregular skin loss. They underwent homodigital oblique neurovascular advancement flap described by Venkatswami with or without skin grafting for donor defects and no bone shortening of distal phalanx. Patients were assessed for time out of dressing, recovery in sensation and range of motion, patient satisfaction and return to work

Results and Conclusions: Middle finger was most commonly affected with industrial accidents being the most common cause. All 22 flaps were viable and did not need any dressing by 21 days. Patients were followed up for a minimum of 6 months with the longest follow-up being for 14 months. One patient had stitch abscess which resolved with local measures and oral antibiotics. One patient who had associated uncontrolled diabetes ended with 20 degree flexion contracture at distal interphalangeal joint. One patient with allen 4 type developed hooking of nail. All patients had preserved sensation, no cold intolerance, no scar tenderness and returned to their original occupation between 3 to 5 weeks. 18 patients were satisfied with the procedure in terms of appearance and function graded on a scale of 1 to 10.

In irregular allen 3 or 4 finger tip amputations, this oblique homodigital neurovascular advancement flap provides adequate cover with fast recovery to pre injury occupation and full preservation of sensations in the fingertip.