[Modification of finger replantation after ring avulsion injury--a case raport]

Modification of replantation after total amputation of the fourth finger caused by ring avulsion injury was presented. It can be applied in finger amputations with bone or joint injury at the level or close to DIP joint. In proposed modification distal phalanx is removed from amputated part and remaining pulp tissues are transferred to middle phalanx. It enables primary vessel anastomoses after excision of their damaged ends. Moreover, it eliminates necessity of bone stabilization and tendon repair, shortens operation time, rehabilitation period and allows for earlier return to professional activity. This unique solution is particularly indicated in physical workers. Presented modification of finger replantation was successfully used in 44-year old female farmer. Despite 2 cm shortening of the fourth finger, vein grafts were used in restoration of blood outflow. Due to prolonged ischemia time significant edema of the dorsal aspect of the finger was present. Primary venous anastomoses were not possible due to resultant increased tension. All replanted tissues survived with good functional result. One year after the replantation and 2 months after the FDS tenolysis TAM was 180. Hand was aesthetically accepted by the patient.