Replantation of fingertip amputation by using the pocket principle in adults

There are several treatment modalities for zone 1 or zone 2 fingertip amput ations that cannot be replanted by using microsurgical techniques, such as delayed secondary healing, stump revision, skin graft, local flaps, distant flaps, and composite graft. Among these, composite graft of the amputated digit tip is the only possible means of achieving a full-length digit Kith a normal nail complex. The pocket principle can provide an extra blood supp ly for survival of the composite graft of the amputated finger by enlarging the area of vascular contact. The surgery was performed in two stages. The amputated digit was debrided, deepithelialized, and reattached to the prox imal stump. The reattached finger was inserted into the abdominal pocket. A bout 3 weeks later, the finger was removed from the pocket and covered with a skin graft. We have consecutively replanted 29 fingers in 25 adult patie nts with fingertip amputations by using the pocket principle.,ill were comp lete amputations with crushing or avulsion injuries. Average age was 33.64 years, and men were predominant. The right hand, the dominant one. was more frequently injured, with the middle finger being the most commonly injured . Of the 29 fingers, 16 (55.2 percent) survived completely and 10 (34.5 per cent) had partial necrosis less than one-quarter of the length of the amput ated part. The results of the above 26 fingers were satisfactory From both functional and cosmetic aspects. Twenty of the 29 fingers, which had been f ollowed up for more than 6 months (an average of 16 months), were included in a sensory evaluation. Fifteen of these 20 fingers (75 percent) were clas sified as "good" (static two-point discrimination of less than 8 mm and nor mal use). From the overall results and our experience, we suggest that the pocket principle is a safe and valuable method in replantation of zone 1 or zone I! fingertip amputation, an alternative to microvascular replantation , even in adults.