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Controversies in the Treatment of Fingertip Amputations in Adults: Conservative Versus Surgical Reconstruction

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Controversies in Orthopedic Surgery of The Upper Limb

Abstract

Injuries to the fingertips cause an estimated 4.8 million visits to emergency departments in the USA each year. Although multiple treatments are available (surgical and nonsurgical), none is currently the gold standard. Currently, with the development of microsurgery, if the amputated part is in good condition, replantation is a gold standard intervention. If replantation is not performed, there are multiple chirurgical/nonsurgical options depending on the type of injury, the patient’s characteristics, and the surgeon’s preferences. The development of regenerative medicine would offer an ideal solution that today is still in very early stages.

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References

  1. Kawaiah A, Thakur M, Garg S, Kawasmi SH, Hassan A. Fingertip injuries and amputations: a review of the literature. Cureus. 2020;12(5):e8291.

    PubMed  PubMed Central  Google Scholar 

  2. Peterson SL, Peterson EL, Wheatley MJ. Management of fingertip amputations. J Hand Surg Am. 2014;39:2093–101.

    Article  PubMed  Google Scholar 

  3. Sindhu K, DeFroda SF, Harris AP, Gil JA. Management of partial fingertip amputation in adults: operative and non operative treatment. Injury. 2017;48:2643–9.

    Article  PubMed  Google Scholar 

  4. Lee LP. A simple end efficient treatment for fingertip injuries. J Hand Surg Br. 1995;20:63–71.

    Article  CAS  PubMed  Google Scholar 

  5. Fox JW 4th, Golden GT, Rodeheaver G, Edgerton MT, Edlich RF. Nonoperative management of fingertip pulp amputation by occlusive dressings. Am J Surg. 1977;133:255–6.

    Article  PubMed  Google Scholar 

  6. Simman R, Hermans MHE. Managing wounds with exposed bone and tendon with an esterified hyaluronic acid matrix (eHAM): a literature review and personal experience. J Am Coll Clin Wound Spec. 2018;9:1–9.

    PubMed  PubMed Central  Google Scholar 

  7. Farrell RG, Disher WA, Nesland RS, Palmatier TH, Truhler TD. Conservative management of fingertip amputations. JACEP. 1977;6:243–6.

    Article  CAS  PubMed  Google Scholar 

  8. Krauss EM, Lalonde DH. Secondary healing of fingertip amputations: a review. Hand (N Y). 2014;9:282–8.

    Article  PubMed  Google Scholar 

  9. Champagne L, Hustedt JW, Walker R, Wiebelhaus J, Nystrom NA. Digital tip amputations from the perspective of the nail. Adv Orthop. 2016;2016:1967192.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Allen MJ. Conservative management of finger tip injuries in adults. Hand. 1980;12:257–65.

    Article  CAS  PubMed  Google Scholar 

  11. Lefèvre Y, Mallet C, Ilharreborde B, Jehanno P, Frajmann JM, Penneçot GF, et al. Digital avulsion with compromised vascularization: study of 23 cases in children. J Pediatr Orthop. 2011;31:259–65.

    Article  PubMed  Google Scholar 

  12. Merle M, Dautel G. Amputations d’attente et amputations definitives. In: La main traumatique. Tome 1. Paris: Masson; 1997. pp. 251–253.

    Google Scholar 

  13. Boudard J, Loisel F, El Rifaï S, Feuvrier D, Obert L, Pluvy I. Fingertip amputations treated with occlusive dressings. Hand Surg Rehabil. 2019;38:257–61.

    Article  CAS  PubMed  Google Scholar 

  14. Masaki S, Kawamoto T. Fingertip amputation injury of Allen type III managed conservatively with moist wound dressings. Am J Case Rep. 2021;22:e928950.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Ng HJH, Sim J, Tey VHT, Selvaganesh S, Rebosura CKP, Rajaratnam V. Experience with the use of splint caps for the management of fingertip amputation injuries. J Hand Surg Asian Pac. 2020;25:199–205.

    Article  Google Scholar 

  16. Butler DP, Murugesan L, Ruston J, Woollard AC, Jemcc B. The outcomes of digital tip amputation replacement as a composite graft in a paediatric population. J Hand Surg Eur. 2016;41:164–70.

    Article  CAS  Google Scholar 

  17. Chen SY, Wang CH, Fu JP, Chang SC, Chen SG. Composite grafting for traumatic fingertip amputation in adults: technique reinforcement and experience in 31 digits. J Trauma. 2011;70:148–53.

    PubMed  Google Scholar 

  18. Hirasé Y. Postoperative cooling enhances composite graft survival in nasal-alar and fingertip reconstruction. Br J Plast Surg. 1993;46:707–11.

    Article  PubMed  Google Scholar 

  19. Adani R, Marcoccio I, Tarallo L. Treatment of fingertips amputation using the Hirase technique. Hand Surg. 2003;8:257–64.

    Article  CAS  PubMed  Google Scholar 

  20. Idone F, Sisti A, Tassinari J, Nisi G. Cooling composite graft for distal finger amputation: a reliable alternative to microsurgery implantation. In Vivo. 2016;30:501–5.

    PubMed  Google Scholar 

  21. Lai HT, Wu SH, Lai YW, Hsieh TY, Lee SS, David Wang HM, et al. Composite grafting with pulp adipofascial advancement flaps for treating non-replantable fingertip amputations. Microsurgery. 2016;36:651–7.

    Article  PubMed  Google Scholar 

  22. Elzinga K, Chung KC. Non-microsurgical composite grafting for acute management of fingertip amputation. Hand Clin. 2021;37:43–51.

    Article  PubMed  Google Scholar 

  23. Shepard GH. Treatment of nail bed avulsions with split-thickness nail bed grafts. J Hand Surg Am. 1983;8:49–54.

    Article  CAS  PubMed  Google Scholar 

  24. Young FC, Teoch LC. Nail bed reconstruction with split-thickness nail bed grafts. J Hand Surg Br. 1992;1:193–7.

    Article  Google Scholar 

  25. Lee JH, Burn JS, Kang SY, Yang WY. Full-thickness skin grafting with de-epithelization of the wound margin for finger defects with bone or tendon exposure. Arch Plast Surg. 2015;42:334–40.

    Article  PubMed  PubMed Central  Google Scholar 

  26. Yeo C, Sebastin SJ, Chong AKS. Fingertip injuries. Singap Med J. 2010;51:78–86.

    CAS  Google Scholar 

  27. Martin-Playa P, Foo A. Approach to fingertip injuries. Clin Plastic Surg. 2019;46:275–83.

    Article  Google Scholar 

  28. Atasoy E, Ioakimidis E, Kasdan ML, Kutz JE, Kleinert HE. Reconstruction of the amputated finger tip with atriangular volar flap. A new surgical procedure. J Bone Joint Surg Am. 1970;52:921–6.

    Article  CAS  PubMed  Google Scholar 

  29. Evans DM, Martin DL. Step- advancement island flap for finger-tip reconstruction. Br J Plast Surg. 1988;41:105–11.

    Article  CAS  PubMed  Google Scholar 

  30. Tupper J, Miller G. Sensitivity following volar V-Y plasty for fingertip amputations. J Hand Surg Br. 1985;10:183–4.

    Article  CAS  PubMed  Google Scholar 

  31. Tempest MN. Cross-finger flaps in the treatment of injuries to the finger tip. Plast Reconstr Surg. 1946;1952(9):205–22.

    Google Scholar 

  32. Miller AJ. Single finger tip injuries treated by thenar flap. Hand. 1974;6:311–4.

    Article  CAS  PubMed  Google Scholar 

  33. Melone CP, Beasley RW, Carstens JH Jr. The thenar flap. An analysis of its use in 150 cases. J Hand Surg Am. 1982;7(291):297.

    Google Scholar 

  34. Rabarin F, Saint Cast Y, Jeudy J, Fouque PA, Cesari B, Bigorre N, et al. Cross-finger flap for reconstruction of fingertip amputations: Long-term results. Orthop Traumatol Surg Res. 2016;102(4 Suppl):S225–8.

    Article  CAS  PubMed  Google Scholar 

  35. Chen YC, Chan FC, Hsu CC, Lin YT, Chen CT, Lin CH. Fingertip replantation without venous anastomosis. Ann Plast Surg. 2013;70:284–8.

    Article  CAS  PubMed  Google Scholar 

  36. Kwon YJ, Ahn BM, Lee JS, Park YG, Ryu HJ, Ha YC. Reconstruction of two fingertip amputations using a double thenar flap and comparison of outcomes of surgery using a single thenar flap. Injury. 2017;48:481–5.

    Article  PubMed  Google Scholar 

  37. Kayalar M, Bal E, Toros T, Sügün ST, Ozaksar K, Gürbüz Y. The outcome of direct-flow neurovascular island flaps in pulp defects. Acta Orthop Traumatol Turc. 2011;45:175–84.

    Article  PubMed  Google Scholar 

  38. Kayalar M, Bal E, Toros T, Ozaksar K, Sügün ST, Ademoglu Y. The results of reverse-flow island flap in pulp reconstruction. Acta Orthop Traumatol Turc. 2011;45:304–11.

    PubMed  Google Scholar 

  39. Tsai TM, Yuen JC. A neurovascular island flap for volar oblique fingertip amputations. Analysis of long-term results. J Hand Surg Br. 1996;21:94–8.

    Article  CAS  PubMed  Google Scholar 

  40. Alagoz MS, Uysal CA, Kerem M, Sensoz O. Reverse homodigital artery flap coverage for bone and nail bed grafts in fingertip amputations. Ann Plast Surg. 2006;56:279–83.

    Article  CAS  PubMed  Google Scholar 

  41. Sir E, Aksoy A, Aksoy MK. Comparisons between long-term outcomes of the reposition flaps and replantations in finger amputations. Ulus Trauma Acil Cerrahi Derg. 2018;24:462–7.

    Google Scholar 

  42. Hassanpour SE, Hosseini SN, Abdolzadeh M. Purse-string suture as a complementary technique with conventional flaps in repairing fingertip amputation. Tech Hand Up Extrem Surg. 2011;15:94–8.

    Article  PubMed  Google Scholar 

  43. Brent B. Replantation of amputated distal phalangeal parts of fingers without vascular anastomoses, using subcutaneous pockets. Plast Reconstr Surg. 1979;63:1–8.

    Article  CAS  PubMed  Google Scholar 

  44. Arata J, Ishikawa K, Soeda H, Sawabe K, Kokoroishi R, Togo T. The palmar pocket method: an adjunct to the management of zone I and II fingertip amputations. J Hand Surg Am. 2001;26:945–50.

    Article  CAS  PubMed  Google Scholar 

  45. Jung MS, Lim YK, Hong YT, Kim HN. Treatment of fingertip amputation in adults by palmar pocketing of the amputated part. Arch Plast Surg. 2012;39:404–10.

    Article  PubMed  PubMed Central  Google Scholar 

  46. Mitsunaga N, Mihara M, Koshima I, Gonda K, Takuya I, Kato H, et al. Digital artery perforator (DAP) flaps: modifications for fingertip and finger stump reconstruction. J Plast Reconstr Aesthet Surg. 2010;63:1312–7.

    Article  PubMed  Google Scholar 

  47. Van Handel AC, Pet MA. Fingertip replantation: technique details and review of the evidence. Hand Clin. 2021;37:53–65.

    Article  PubMed  Google Scholar 

  48. HattoriY DK, Ikeda K, Estrella EP. A retrospective study of functional outcomes after successful replantation versus amputation closure for single fingertip amputations. J Hand Surg Am. 2006;31:811–8.

    Article  Google Scholar 

  49. Ozcelik IB, Purisa H, Mersa B, Sezer I, Erturer E, Ergun O. Late results of replantations in tip amputation of the thumb. Acta Orthop Traumatol Turc. 2008;42:252–7.

    Article  PubMed  Google Scholar 

  50. Gelberman RH, Urbaniak JR, Bright DS, Levin LS. Digital sensibility following replantation. J Hand Surg. 1978;3:313–9.

    Article  CAS  Google Scholar 

  51. Irwin MS, Gilbert SE, Terenghi G, Smith RW, Green CJ. Cold intolerance following peripheral nerve injury. Natural history and factors predicting severity of symptoms. J Hand Surg Br. 1997;22:308–16.

    Article  CAS  PubMed  Google Scholar 

  52. Wang K, Sears ED, Shauver MJ, Chung KC. A systematic review of outcomes of revision amputation treatment for fingertip amputations. Hand. 2013;8:139–45.

    Article  PubMed  PubMed Central  Google Scholar 

  53. Yoon AP, Mahajani T, Hutton DW, Chung KC. Cost-effectiveness of finger replantation compared with revision amputation. JAMA Netw Open. 2019;2(12):e1916509. 1/14.

    Article  PubMed  PubMed Central  Google Scholar 

  54. Pet MA, Ko JH. Indications for replantation and revascularization in the hand. Hand Clin. 2019;35:119–30.

    Article  PubMed  Google Scholar 

  55. Frykman GK, Wood VE. Saving amputated digits. Current status of replantation of fingers and hands. West J Med. 1974;121:265–9.

    CAS  PubMed  PubMed Central  Google Scholar 

  56. Manktelow RT. What are the indications for digital replantation? Ann Plast Surg. 1978;1:336–7.

    Article  CAS  PubMed  Google Scholar 

  57. O’Brien BM, MacLeod AM, Miller GD, Newing RK, Hayhurst JW, Morrison WA. Clinical replantation of digits. Plast Reconstr Surg. 1973;52:490–502.

    Article  PubMed  Google Scholar 

  58. Lin CH, Aydyn N, Lin YT, Hsu CT, Lin CH, Yeh JT. Hand and finger replantation after protracted ischemia (more than 24 hours). Ann Plast Surg. 2010;64:286–90.

    Article  CAS  PubMed  Google Scholar 

  59. Waikakul S, Sakkarnkosol S, Vanadurongwan V, Un-nanuntana A. Results of 1018 digital replantations in 552 patients. Injury. 2000;31:33–40.

    Article  CAS  PubMed  Google Scholar 

  60. Wong C, Ho PC, Tse WL, Cheng S, Chan DK, Hung LK. Do we need to repair the nerves when replanting distal finger amputations? J Reconstr Microsurg. 2010;26:347–54.

    Article  PubMed  Google Scholar 

  61. Dolan CP, Dawson LA, Muneoka K. Digit tip regeneration biology with regenerative medicine. Stem Cells Translational Med. 2018;7:262–70.

    Article  Google Scholar 

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Bravo, E., Rodríguez-Merchán, E.C. (2022). Controversies in the Treatment of Fingertip Amputations in Adults: Conservative Versus Surgical Reconstruction. In: Rodríguez-Merchán, E.C., Moreno-Garcìa, A. (eds) Controversies in Orthopedic Surgery of The Upper Limb . Springer, Cham. https://doi.org/10.1007/978-3-031-04907-1_19

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  • DOI: https://doi.org/10.1007/978-3-031-04907-1_19

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