Management of Fingertip and Thumb Tip Amputations

Abstract

Management of a digital tip amputation requires a thorough understanding of fingertip anatomy, vascular anatomy, and the various treatment options available. The goals of treatment include facilitating the fastest reasonable recovery, restoring volar soft-tissue pulp and contour, maintaining digital tip support, achieving a pain-free and sensate tip, and tailoring the type of reconstruction to the patient's occupational and avocational needs. Treatment options include healing by secondary intention, skin grafting, bone shortening and amputation revision, complex flap reconstruction, and replantation. The option selected will depend on the tissues involved, pathologic anatomy of the injury, personal needs of the patient, and vascularity of the fingertip. Complications of treatment include nail deformity, painful unstable scar, digital neuroma, cold intolerance, dysesthesias, hypesthesias, poor aesthetics, stiff digits with flexion contracture, and flap necrosis.

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