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Clinical Example: Amputation revision, digital nerves implanted into bone
| This
patient had a thumb tip avulsive amputation treated elsewhere with a V-Y
advancement flap. There was inadequate soft tissue cover, terminal digital
neuromas, poor vascularity of the tip, constant aching pain and persistent
tenderness. Out of the variety of treatment options, including another
try to add more skin to the tip with a flap, the patient chose amputation
revision. |
| Click on each image
for a larger picture |
| Nail
visible from the palm. The previous flap did not provide enough padding
for the tip. |
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| The
thumb preop: hook nail deformity: |
 |
| Bone
tip just beneath the skin, line on the film traces the thumbnail edge. |
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| In
the amputation revision as a DIP disarticulation, the palmar digital nerves
are buried in drill holes the head of the proximal phalanx to avoid sensitive
neuroma symptoms. |
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| Final
result, actually very gratifying. Pain free for the fist time since the
injury, now able to loudly snap thumb and index finger. |
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| Drill holes in the bone with protected
intraosseous neuroma. |
 |
 |
American
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Hand
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Resource
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Period.
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