• Xiao Zhou, Libo Wang, Jingyi Mi, Yajun Xu, Yongjun Rui, Mingyu Xue, Xiaofang Shen, and Li Qiang.
• Department of Hand Surgery, The Ninth People's Hospital of Wuxi City, Suzhou University, No.999 Liangxi Road, Wuxi, 214062, China.
• Arch Orthop Trauma Surg. 2015 Apr 1; 135 (4): 589594589-94.

IntroductionThe aim of treating thumb fingertip amputations with no indication for replantation is to reestablish functional and esthetic properties.Materials And MethodsFrom March 2005 to October 2008, we treated 14 patients with thumb fingertip amputation using palmar V-Y flaps combined with bone and nail bed grafts. There were 10 men and 4 women, whose ages at surgery ranged from 19 to 63 years (mean 35.8 years). In all, 11 of the injuries occurred in the dominant hand. According to Allen's classification, two were type II, seven were type III, and five were type IV. All patients underwent emergency surgery, with a time delay after injury of 3-12 h (mean 6.4 h). In each case, the amputation was a crush or avulsion injury, making microsurgical replantation not feasible.ResultsAll of the flaps survived. At 8-17 months (average 12.8 months) of follow-up, the average subjective satisfaction score was 8.64. All patients experienced cold intolerance, and none of the patients complained of dysesthesia. Favorable results (excellent or good) were found in 78.6%. Thin primary nails appeared on the grafted nail bed about 3 weeks after surgery, following which the newly formed nail thickened and developed a more natural appearance. In one case, the new nail plate showed abnormal thickening due to hyperkeratosis. The bone graft healed at 5 weeks. The mean two-point discrimination was 7.5 mm. Grip strength was 10% less than that in the unaffected hand. Metacarpophalangeal and proximal interphalangeal joint mobility losses were less than 10°. All patients returned to their jobs. No patients had postoperative complications.ConclusionsWe believe that the combination of palmar V-Y flap and bone and nail bed grafts provides a distinct advantage over other choices. It improves function when replantation is not an option.

21 keywords...

hide…