Micro-vascular surgery in fingertip injury treatment: Case report

Abstract

A high priority for fingertip injury reconstruction is the restoration of skin cover to protect underlying bone, tendon,
and nerve structures. Other priorities are to maintain or maximize sensibility, preserve digit length, and minimize
cosmetic deformity. Because it is so highly visible, though, the appearance of the reconstructed digit should be as
normal as possible. Therefore, microvascular surgery has an important role in management of fingertip injuries to
give a normal shape of the digit. In this case, a clinical experience using microvascular surgery in the treatment of
fingertip injury was reported. In early 2007, there were two fingertip injury cases which were reconstructed using
microvascular surgery modality. The first case was a 34 years old male who had defect in soft tissue of the fourth
finger in his right hand caused by pressed machine. We performed elective wound reconstruction by transferring the
skin and soft tissue freely (free pulp transfer) along with the vasculatures taken from fibular side of great toe in the
right foot. Revascularization was performed by connecting deep plantar artery/vein with common digital artery/vein
at the injured digit. The second case, was a 29 years old female with clean-cut amputation of the distal part of the
third finger in the right hand (Allen’s type IV). We performed replantation in the first 16 hours after injury. We
reanastomosed the ulnar side of digital artery only without vein and nerve reanastomosis. To avoid the distal edema,
we did not perform any skin suture and let the oozing from the vein backflow. In both cases, we have excellent
appearance result, moderate usefulness of the finger, but still poor in sensibility.
Key words: clinical experiences - fingertip injury - soft tissue defect - clean cut amputation - microvascular surgery
- free pulp transfer - replantation.