Reconstruction of fingertip and stump using a composite graft from the hypothenar region

Finger amputation with bone exposure when replantation is not feasible requires a procedure for closure and padding of the stump. To preserve the length and provide adequate coverage, various flaps are used. A situation may occur in which local flaps are not sufficient and distant flaps are preferred. However, distant flaps often require a two-stage procedure, prolonged immobilization, and skin grafts. Thus, a simpler approach for fingertip or stump reconstruction while maintaining the padding effect of a flap was designed. The composite of glabrous skin and subcutaneous fat provided such padding, was performed in a single stage, and the donor site morbidity was negligible. During a 5-year period from 1996 to September 2002, 15 cases of finger stumps were reconstructed using the hypothenar composite graft. The age of the patients ranged from 1 to 63 years (average, 30 years). The average follow-up was 35 months. The donor sites were closed primarily and there were no marked complications related to this site. The graft showed relatively good contour and color match to the adjacent field, with an average two-point discrimination of 5.7 mm, indicating satisfactory reinnervation. The hypothenar composite graft for reconstruction of finger stumps can provide protective padding, maximal stump length, and minimal donor site morbidity, leading to satisfactory aesthetic and functional recovery.