gms | German Medical Science

Objectives/Interrogation: Amputation of the fingertip with loss of the pulp, exposed bone and nail bed injury is a common problem, not infrequently neglected. Fingertip reconstruction requires new pulp glabrous skin coverage with sensitivity buttressed by the nail. Traditional management techniques may leave a much shorter hypersensitive stump, with joint stiffness, cold intolerance and prolonged disability. The aim of this study is the analysis of our experience from the use of homodigital island flap for the reconstruction of amputated fingertips.

Methods: The homodigital island flap was applied in 52 patients (65 fingers), at every level of finger amputation with special indication on fingertip coverage. The procedure was carried out under axillary or wrist block using magnifying loupes. For the index and the middle fingers, use of the ulnar bundle is preferred. For the thumb, ring and little finger use of the radial neurovascular bundle is used. The neurovascular bundle is well dissected from the flap to the base of the finger. After suturing of the flap the donor area is covered with split thickness graft from the hypothenar. The finger is mobilized one week after the procedure.

Results and Conclusions: Follow up ranged from 14 to 94 months (mean 46 months). Postoperatively, range of motion was normal in 50 fingers, 8 fingers had 10 degrees loss of extension at the DIP joint and 7 fingers had loss of motion between 10 and 20 degrees. Two-point discrimination was 4mm (from 3 to 10mm). Three patients had cold intolerance for 8 months. There was no neuroma or sensitive scar formation and no need for a second operation. According to patients cosmesis was acceptable to all fingers.

The use of homodigital island flap provides excellent functional reconstruction of the fingertips after a complex tissue loss in Allen II, III, and IV amputations. It is a straightforward operation that provides very satisfactory results.