SALVAGE OF FINGERTIP AMPUTATED AT NAIL LEVEL - NEW SURGICAL PRINCIPLES AND TREATMENTS

In this study, a new classification of fingertip amputation based on t he surgical treatment is reported. Specifically, the necessity for spe cial procedures to prevent venous congestion in fingertip replantation at the nail bed level was studied. There are some reports of successf ul replantations without venous anastomoses. In order to avoid technic al factors, clinical cases operated on by a single surgeon were evalua ted to determine what treatment is necessary for amputations at variou s levels to avoid necrosis due to venous congestion. During the 5-year period from October 1987 to October 1992, 150 replantations in 137 pa tients were performed, including 49 fingertip replantations in 45 pati ents who were operated on consecutively by a single surgeon. The dista l phalanx (DP) of the finger was classified as zone DP-I, IIA, IIB, an d III from distal to proximal. This classification was based not only on the amputation level but also on the difference in surgical treatme nt. For amputations of zone OF-I, which extends from the fingertip to the most distal dividing point of the digital artery, the amputated fi ngertip is attached without vascular anastomosis and the whole finger is wrapped in aluminium fail and cooled in ice water for 3 days. For a mputations of zone DP-IIA and IIB, anastomosis of the digital artery i s performed in the central portion of the palmar region of the finger, but Kirschner wire fixation is not performed so as not to disturb the venous drainage through the medullary cavity. For amputations of zone DP-IIA, special treatment is not necessary for venous congestion, and for those of zone DP-IIB partial resection of the nail is done if nec essary,: For zone DP-II amputations, venous anastomosis must be perfor med for salvage. All patients were operated on according to the proced ures based on this classification and final survival rate was 91.5%.