Fingertip, finger and thumb amputations are unfortunately common. Replantation of amputations at any level from shoulder to fingertip pulp is technically possible and has been performed for years. Replantation is a considerable undertaking, more so for the patient than for the surgeon, because it usually involves a prolonged recovery period, often multiple operations, intensive therapy and when complete, it is realistic to expect only partial recovery of range of motion and sensation. If replantation is a consideration, a regional center performing replantation surgery should be contacted to confirm with the receiving surgeon that referral for replantation is appropriate and that such services will be available. Replantation obviously does not take precedence over potentially life-threatening injuries, and particularly in a blunt trauma scenario such as a motor vehicle accident, the drama of the amputation should not be allowe d to curtail thorough evaluation for other more dangerous injuries.
If replantation is not performed, amputation wounds may require skeletal shortening for simple primary closure. Skeletal shortening should be avoided in the digits if possible, for a relatively small loss of length may critically change the functional outcome of the digit. Fingertip amputation is the most common situation to test the knowledge and ingenuity of the surgeon. Pure soft tissue fingertip defects measuring 1 cm in diameter or less may be treated with dressing changes, allowing the wound to heal by secondary intent. If the defect extends to the distal nail bed, the scar will come to lie beneath the fingernail and may not be visible. Larger defects or those in which bone is exposed require flap cover. Many flaps have been described for fingertip cover. The three most common and useful regional flaps for fingertip cover are the central V-Y palmar advancement flap, the thenar flap, and the dorsal cross finger fla p (Fig. 21). The three most common and useful regional flaps for thumb tip cover are the Moberg palmar advancement flap, dorsal cross finger flap from the index finger, and neurovascular island flap (Fig. 22a) (Fig. 22b) (Fig. 22c) (Fig. 22d).

Hand Amputation
Finger Amputation
 

e-Hand

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