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Tamai Zone 1 Fingertip Amputation: Reconstruction Using a Digital Artery Flap Compared With Microsurgical Replantation

https://doi.org/10.1016/j.jhsa.2019.03.016Get rights and content

Purpose

The surgical treatment of fingertip amputations is controversial. This study was designed to compare the clinical results of 2 surgical procedures for fingertip amputation: reconstruction with a digital artery flap and microsurgical replantation.

Methods

Between 2003 and 2015, 37 patients with Tamai zone 1 fingertip amputation of the index or middle finger were treated by reconstruction with a digital artery flap (n = 23) or microsurgical replantation (n = 14). Data for these patients were evaluated retrospectively. Nerve suture was not conducted in microsurgical replantation because spontaneous sensory recovery is expected in zone 1 replantation. Primary outcomes included hand dexterity (Purdue Pegboard Test), and disability of the upper extremity (Disabilities of the Arm, Shoulder, and Hand score). Secondary outcomes included strength (key pinch), digital sensitivity (Semmes-Weinstein test), and finger mobility (% total active motion).

Results

The average follow-up period was 34 months. There was no significant difference in the primary outcomes between the 2 groups. The reconstruction group showed significantly better results for the secondary outcomes.

Conclusions

This study suggests that the 2 procedures were comparable regarding postoperative activities of daily living and hand performance, but reconstruction using a digital artery flap gave better objective functional outcomes than microsurgical replantation.

Type of study/level of evidence

Therapeutic IV.

Section snippets

Patients

The subjects were 37 patients who underwent treatment of finger amputations by replantation (n = 14) or reconstruction using a digital artery flap (n = 23) (Table 1). The inclusion criteria were a single fingertip amputation of the index or middle finger in Tamai zone 1 (fingertip to the base of the nail in the Tamai zone classification9, 10) that was treated by microsurgical replantation (Fig. 1) or reconstruction using a digital artery flap (Fig. 2) as the primary procedure. No patient

Results

Patient demographics were similar between the replantation and the reconstruction groups for age and sex, distribution of injured digit (index or middle finger), hand dominance, and mechanism of injury. The mean hospital stays were 14 and 3 days, respectively, but the follow-up period for patients in the reconstruction group was longer.

All replanted digits and all flaps survived completely, and there were no complications of infection, cold intolerance, or chronic regional pain syndrome as

Discussion

Surgical options for treatment of fingertip amputation vary depending on the preferences of surgeons and patients, but there have been few comparative studies on outcomes for the different procedures.1, 2 Only 1 report has compared the functional outcomes of fingertip replantation versus revision amputation,3 and a few studies have compared outcomes of reconstruction using a digital artery flap and microsurgical replantation.1, 2 In the current study, both procedures were comparable regarding

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© 2019 by the American Society for Surgery of the Hand. All rights reserved.