Classification of Distal Fingertip Amputation Based on the Arterial System for Replantation

Abstract

During replantation of distal fingertip amputation, identification of the artery is the most important but time consuming procedure. Depending on the damaged arterial structure, we classified distal fingertip amputations into 4 zones, on the basis of three dimensional concept. Zone 1 injury was defined as damage to the proximal central pulp artery; zone 2 injury, damage to the branch of the central pulp artery; zone 3 injury, damage to the distal central pulp artery; and zone 4 injury, no injury to the central pulp artery, injury only to the lateral pulp artery. From April 2010 to June 2011, 27 patients were evaluated. Successful replantation was observed in 21 patients. Skin necrosis occurred in six patients. For distal fingertip amputation classification based on the damaged arterial system is an easy method to find out the appropriate artery which should be anastomosed during replantation.

Keywords

Replantation - Distal fingertip amputation - Central pulp artery

• References

• 1 Shi D, Qi J, Li D, Zhu L, Jin W, Cai D. Fingertip replantation at or beyond the nail base in children. Microsurgery 2010; 30 ((5)) 380-385
• 2 Yamano Y. Replantation of the amputated distal part of the fingers. J Hand Surg Am 1985; 10 ((2)) 211-218
• 3 Foucher G. Distal replantation. J Hand Surg Am 1986; 11 ((3)) 456-457
• 4 Sebastin SJ, Chung KC. A systematic review of the outcomes of replantation of distal digital amputation. Plast Reconstr Surg 2011; 128 ((3)) 723-737
• 5 Koshima I, Urushibara K, Fukuda N, Ohkochi M, Nagase T, Gonda K, Asato H, Yoshimura K. Digital artery perforator flaps for fingertip reconstructions. Plast Reconstr Surg 2006; 118 ((7)) 1579-1584
• 6 Scheker LR, Becker GW. Distal finger replantation. J Hand Surg Am 2011; 36 ((3)) 521-528
• 7 Cheng GL, Pan DD, Yang ZX, Qu ZY. Replantation of digits amputated at or about the distal interphalangeal joint. Ann Plast Surg 1985; 15 ((6)) 465-473
• 8 Atasoy E, Ioakimidis E, Kasdan ML, Kutz JE, Kleinert HE. Reconstruction of the amputated finger tip with a triangular volar flap. A new surgical procedure. J Bone Joint Surg Am 1970; 52 ((5)) 921-926
• 9 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 ((1)) 148-153
• 10 Kutler W. A new method for finger tip amputation. J Am Med Assoc 1947; 133 ((1)) 29
• 11 Tempest MN. Cross-finger flaps in the treatment of injuries to the finger tip. Plast Reconstr Surg 1952; 9 ((3)) 205-222 (1946)