Finger amputations

Presentation

• Examination
  • Presence or absence of exposed bone
  • Flexor/extensor tendon involvement

Management

• Goals
  • Sensate tip
  • Durable tip
  • Bone support for nail growth

Non-operative

• • Indications
    • Adults and children with no bone or tendon exposed with <2cm of skin loss
    • Children with exposed bone
  • Components
    • Irrigation and soft dressing
    • After 7-10 days, soak in water-peroxide solution daily followed by application of soft dressing and fingertip protector
    • Complete healing takes 3-5 weeks

Operative

Primary closure (revision amputation/terminalisation)

• • • Finger amputation with exposed bone and the ability to rongeur bone proximally without compromising bony support to nailbed
    • Technique
      • Must ablate remaining nail matrix
      • If flexor or extensor tendon insertions cannot be preserved, disarticulate the DIP joint
      • Transect digital nerves and remaining tendons as proximal as possible
      • Palmar skin brought over bone and sutured to dorsal skin - can use V-Y advancement flap

Full thickness skin grafting from hypothenar region

• • • Fingertip amputation with no exposed bone and >2cm of tissue loss
    • Don't use STSG - contractile, tender, less durable
    • Close the donor site primarily, suture the graft over the defect
    • Remove the dressing and encourage range of motion after 7 days

Flap reconstruction

• • • Exposed bone or tendon where rongeuring bone proximally is not an option