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[Investigation of new classification and repair methods for fingertip traverse amputation]
Xiao Zhou1, Yajun Xu, Yongjun Rui
1Wuxi Hand Surgery Hospital, Wuxi Jiangsu, 214061, P.R. China. zhoudaxiao@sina.com
Objective:
To investigate new classification and repair methods for the traverse amputated fingertip.
Methods:
From March 2000 to October 2006, 20 cases of 20 fingers with traverse amputated fingertip, including 13 males and 7 females aged 17-47 years, were treated. Twenty patients (9 crush injuries, 5 cutting injuries and 6 sawing injuries) were classified into 4 types, namely type I (the distal one third of nail bed), type II (the middle of nail bed), type III (the proximal one third of nail bed), and type IV (the root of nail bed). There were 3 patients (2 index fingers and 1 little finger) of type I, 8 patients (2 thumbs, 3 index fingers and 3 middle fingers) of type II, 5 patients (3 index fingers, 1 ring finger and 1 little finger) of type III, and 4 patients (2 thumbs, 1 middle finger and 1 little finger) of type IV. The soft tissue defect ranged from 1.2 cm x 1.2 cm to 1.5 cm x 1.2 cm. The time from injury to surgery was 3-10 hours. Fingers of type I and type II were treated with forward flow axial flap and modified nail bed lengthening. Fingers of type III and type IV were treated with forward flow axial flap and partial nail bed replantation as well as modified nail bed lengthening. The flaps ranged in size from 1.5 cm x 1.2 cm to 2.0 cm x 1.4 cm.
Results:
Twenty patients incisions healed by first intention and the flaps, nails and skin grafting survived. All donor sites healed by first intention. All patients were followed up for 2-6 months (4 months on average). The appearances of fingertips were good. The texture of the flap was soft, and the fingers had no tenderness and motor disturbance. The two-point discrimination was 4.5-6.5 mm. The finger nails of type I and type II extended 3-4 mm after operation, while the finger nails of type III and type IV extended 8-10 mm after operation. All finger nails were smooth and flat without pain. Hook nail happened in 1 case 6 months after operation.
Conclusion:
Classification of the injured fingers according to the condition of the amputation base is helpful in choosing repair methods, and is conducive to maximize the recovery of the function and shape of fingertips.
