Repositioning and flap placement in fingertip injuries

After finger amputations, replantation is often the best option of treatment. However, microvascular repair may not be feasible for more distal amputations. Reposition of the amputated segment associated with a local flap can provide length, sensation, and bulk. This is especially useful in distal-to-distal interphalangeal joint fingertip amputations. From 1994 to 1998, 30 reposition and flap procedures were performed by the authors. In 28 cases, the homodigital unipedicle island flap was used and in two cases the Tranquilli-Leali flap was used. Patients were observed for 24 months to evaluate joint mobility, nail aesthetics and function, as well as sensitivity. Mobility was considered satisfactory in all repositioned segments except two, in which a 20-deg extension deficit at the proximal interphalangeal joint was noticed. Digit length was approximately the same in relation to the opposite side, and the nail did not change markedly from case to case. Two-point discrimination ranged from 7 to 9 mm. Intolerance to cold was observed in 7 patients. Reposition associated with a local flap has been a good surgical alternative for more distal amputations because it preserves digit length and sensitive digital pinch.