Hatchet flap for distal fingertip amputations

- Fingertip amputations are responsible for significant pain, suffering, discomfort as well as lost productivity and financial and physical hardship. Distal finger tip amputations pose a unique reconstructive challenge as the aim is to provide a supple cover with sensation. Wide variety of options are available for the reconstruction following fingertip amputations. This study evaluates the use of hatchet flap in the management of distal fingertip amputations.

The hatchet flap was done in 35 fingers of 31 patients with fingertip amputations at the level of distal phalanx who presented to our unit, fulfilling the inclusion criteria during a period of 18 months. All transverse and dorsal oblique amputations (of any size) at the level of distal phalanx of any age group were included in the study. Volar fingertip amputations at the level of distal phalanx and fingertip amputations associated with other injury over the volar aspect of finger were excluded from the study.

The flap provided a very good padded soft tissue cover with good aesthetic shape to the finger tip. The scars were unnoticeable with an average 2 point discrimination of 6.7 ​mm at 12 weeks post operatively. Paresthesia was noted maximally at 1 week post operative duration. Joint stiffness was not noted in any patient. Most patients were able to return back to their normal daily routine at around 3 weeks. Complete flap necrosis was noted in 1 patient while partial tip necrosis was noted in 2 patients.

The hatchet flap serves as a good local reconstructive flap option which preserves the tactile sensation and is a valuable addition to the wide armamentarium of reconstructive procedures available for treating the distal fingertip amputations.