Our Strategy for Fingertip Amputation

Among finger amputations, fingertip amputations when replanted successfully provide excellent esthetic and functional results with high patient satisfaction [1]. For this reason, we have treated amputations by attempting replantation unless otherwise requested by the patient. Replantation success rates obviously increase when both arterial and venous anastomoses are performed. However, circumstances in which we are limited to performing only an arterial anastomosis occur, such as, (1) unavailability of an adequate vein; (2) crush injury with tissue damage; (3) inability of the patient to tolerate the long surgical time; or (4) unavailability of the operating room staff. There were few sufficient data regarding at which level a replanted fingertip can survive solely on arterial anastomosis. Therefore we performed a statistical review of our clinical data, and reported that up to subzone III (Ishikawa’s subzone), there is a high possibility of replanted fingertips surviving with arterial anastomosis alone [2]. Based on this result, we have established and acted upon a new treatment strategy, and hereby report the favorable outcomes. There have reports that in amputations distal from the DIP joint, sensory recovery is fairly well without nerve repair, so no attempt in nerve repair was made in any cases [3].