Distal Fingertip Replantation without Skeletal Fixation

ABSTRACT

The replantation of fingertip amputation (through the nail bed) requires repair of the artery and vein on the palmar side. These structures are present in different planes, with the artery being deeper and the veins superficial. The authors believe that vascular repair in such cases is facilitated by stabilization of the amputated part by nail-bed repair alone. This provides a certain degree of flexibility, which allows for easier placement of clamps in the limited space available. Although Kirschner wires were not used for bony fixation, bony union was achieved in all five cases in which this technique was used.

KEYWORDS

Fingertip replant - skeleton fixation - technique

REFERENCES

• 1 Tamai S. Twenty years experience of limb replantation.  J Hand Surg. 1982;  7 549-556
• 2 Kim W K, Lim J H, Han S K. Fingertip replantations: clinical evaluation of 135 digits.  Plast Reconstr Surg. 1996;  98 470-476
• 3 Zook E G. Nail bed injuries.  Hand Clin. 1985;  1 701-716
• 4 Akyurek M, Safak T, Kecik A. Fingertip replantation at or distal to the nail base: use of the technique of artery-only anastomosis.  Ann Plast Surg. 2001;  46 605-612
• 5 Hirase Y. Salvage of fingertip amputated at nail level: new surgical principles and treatments.  Ann Plast Surg. 1997;  38 151-157
• 6 Hattori Y, Doi K, Ikeda K, Abe Y, Dhawan V. Significance of venous anastomoses in fingertip replantation.  Plast Reconstr Surg. 2003;  111 1151-1158