The palmar pocket method: an adjunct to the management of zone I and II fingertip amputations

In 1979 Brent reported a new replantation method, without vascular anastomosis, that used a subcutaneous pocket. Brent chose the contralateral chest wall as a pocket site, but in other clinical reports, the abdominal wall was used. For both sites there were complications such as stiffness in the wrist, elbow, and shoulder joints and anxiety about pulling out the pocketed finger. To overcome these problems, we chose the ipsilateral palm and named this method the palmar pocket method. We used this method in 16 cases in which a digit other than the thumb had been amputated between the tip and lunula. In 13 cases the method was completely successful, and in 3 cases there was a small area of tip necrosis. The palmar pocket method is a simple and reliable operation for fingertip reattachment and more comfortable for patients than pocketing in the chest wall or abdominal wall.