Reconstruction of fingertip amputations with full-thickness perionychial grafts from the retained part and local flaps

The treatment of fingertip amputations distal to the distal interphalangeal joint when the amputated part is saved is difficult and controversial. Bot h reattachment of the amputated portion as a composite graft and microvascu lar anastomosis are prone to failure in this distal location. The authors h ave evolved a reconstructive plan that uses the nail matrix, perionychium, and hyponychium of the amputated fingertip as a full-thickness graft when t he amputation is between the midportion of the nail bed and just proximal t o the eponychial fold. Various flaps are used to lengthen and augment the f inger pulp, and skeletal pinning is carried out as necessary. The charts of 15 patients who underwent this procedure over a 38-month period were evalu ated retrospectively. Seven returned to the office for examination at least I year after the fingertip reconstruction described above; four others wer e interviewed by telephone. Nail deformity, fingertip sensation, and joint range of motion were evaluated, and the reconstructed fingertips were photo graphed in standardized views. In six of the seven patients seen in the off ice, aesthetic and functional results were judged as good by both patient a nd physician; one of the six had minimal nail curvature. The seventh patien t had no nail growth, although finger length was retained and there was no functional disability. The four patients interviewed by phone reported norm al fingertip use with no dysesthesias or cold intolerance; all had nail gro wth, although three patients described slight nail curvature that required care in trimming. The authors favor salvage of all perionychial parts when a distal fingertip amputation occurs. Reconstruction of the fingertip with grafting of the hyponychium, perionychium, and nail matrix from the amputat ed part combined with local flaps can provide a very satisfactory functiona l and aesthetic result.