Clinical Example: Open Method of Treating a Fingertip Amputation
| Fingertip amputations are
common. Treatment goals are sensate, stable, nontender soft tissue
cover. Fingertip amputations are described according to the angle of
loss (lateral, dorsal, transverse, palmar), skeletal loss (soft tissue
only, tuft, shaft, base) and zone of injury relating to mechanism of
injury (sharp, crush, saw blade, thermal knife). Optimum treatment is
individualized based on these and other factors. This case demonstrates the "open technique", simply letting nature take its course. The best results and indication for open technique is a dorsal oblique soft tissue amputation. The scar migrates dorsally and proximally, eventually covered by the fingernail. This is an example of this injury and treatment. |
| Click on each image for a larger picture |
| This man's nondominant left
index fingertip was pinched off in a closing furniture door. The
amputated part was crushed flat prior to retrieval. |
| Here, the distal end of the
distal phalanx tuft is visible. |
| The palmar aspect of the
distal phalanx had been previously injured - a transverse distal
laceration involving both digital nerves with good sensory recovery.
The amputation mechanism also produced a new transverse skin rupture
halfway between the old scar and the amputation margin. These new and
old palmar injuries contraindicated palmar advancement flap
reconstruction. Here is the finger the day after injury, back at work, changing bandages.: |
| One week after injury.
Percussive desensitization is underway. |
| 10 days after injury. Still
quite tender to touch. |
| 20 days after injury. The
tip is numb - the fingertip feels as though it us covered by a thimble.
Using the fingertip to tie shoes but not buttons. |
| 30 days after injury: the
fingertip is regaining sensation, but distorted: touching a flat
surface feels sharp, like an edge. Able to pull on socks using this
finger. |
| 40 days after injury.
Recovery seems to slow down - the central healing area is dry, but not
shrinking as fast as it was. No activity limitations, but guitar is
still on hold.. |
| Day 80 - two months. Dramatic tenderness is gone. Fingertip sensation is a strange duality of sharp and dull. Playing some guitar, expecting more improvement. |
This is a 30 second time lapse of the fingertip healing:
| Now two years out. Not normal, but not a problem in any way. The final picture shows the typical fingerprint deformation resulting from the skin stretching up toward the fingernail. |
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