gms | German Medical Science

Objectives/Interrogation: Fingertip amputation is a common hand injury, especially in industrial areas. The ideal treatment is fingertip replantation. However, if the fingertip blood vessels are slender or the damages are severe, replantation makes no sence. This study aimed to provide an objective method of treating fingertip amputations with no indication for replantation is to reestablish functional and esthetic properties.

Methods: During March 2010 and October 2014, 15 patients underwent the treatment of V-Y anvanced flaps combined with bone and nail bed grafts to fingertip reconstruction. Patients' age ranged from 18 to 69 years (mean 35.3 years). All patients underwent emergency surgery, with a time delay after injury of 4-12h (mean 7.1 h). In each case, the amputation was a crush or avulsion injury, making microsurgical replantation not feasible. The defects were located in the nail root in 11 cases and in the middle of nail in 4 cases, the area ranging 1.4 cm × 0.5 cm-1.4cm × 1.1cm in size.

Results and Conclusions: All the flaps and nails survived, and the incisions healed at I stage. The average follow-up time was 12mouths (6-28 mouths). The patients all satisfied with the appearance and the functiocns of the reconstructed fingertip, average subjective satisfaction score was 8.87. The bone graft healed at 6-8 weeks. The mean two-point discrimination was 5-6 mm. The nails graft growth were all flat, no nails, but some slightly smaller than normal. All patients returned to their jobs.

This study shows that V-Y advanced flap combined with bone and nail bed grafts to reconstruct fingertip with no replanted conditions could make the length of the finger and the shape of the nail preserved, and operation simple, which is a valuable new surgical method.