"Reposition-flap": A therapeutic alternative in fingertips amputations

Area of Science:

• Hand surgery
• Trauma reconstruction
• Microsurgery

Background:

• Distal fingertip amputations present challenges in distal fragment quality and replantation viability.
• Current surgical strategies for distal stump coverage are varied and may not always yield optimal results.

Purpose of the Study:

• To introduce and evaluate the "reposition-flap" surgical procedure as an alternative for distal stump coverage after trans-phalanx fingertip amputations.
• To compare the outcomes of the reposition-flap technique with other surgical methods.

Main Methods:

• Retrospective study of 51 patients undergoing fingertip amputation repair between 2001 and 2011 in two hand trauma centers.
• Patients were divided into two groups: "reposition-flap" (20 patients) and other procedures (31 patients, including simple regularization or local flaps).
• Outcomes assessed included sensibility, pulp trophicity, finger mobility, digital length, nail appearance, and radiologic consolidation.

Main Results:

• The reposition-flap procedure achieved 80% phalanx length conservation.
• Significant improvements were noted in nail aesthetics (absence of claw deformity) compared to regularization.
• While Quick DASH scores showed statistical differences, outcomes for interphalangeal joint (IPD) mobility and pulp sensibility were comparable to other methods.

Conclusions:

• The "reposition-flap" surgical procedure is an effective alternative for distal stump coverage in fingertip amputations.
• This technique offers superior aesthetic results and comparable functional outcomes regarding finger mobility and pulp sensitivity.
• The reposition-flap method demonstrates potential for improved overall patient satisfaction in fingertip reconstruction.