Functional and cosmetic results of fingertip replantation: anastomosing only the digital artery.

Abstract

In fingertip amputations, conventional stump plasty provides an almost acceptable functional result. However, replanting fingertips can preserve the nail and minimize loss of function. We investigated the functional and cosmetic results of fingertip replantation at the terminal branch of the digital artery. Outcomes were nailbed width and distal-segment length; sensory recovery; and range of motion (ROM) of thumb-interphalangeal (IP) or finger-distal interphalangeal (DIP) joints, and total active motion (TAM) of the replanted finger. Of 15 fingertips replanted after only arterial anastomosis, 13 were successful, and 12 were studied. After a median of 1.3 years, mean nailbed widths and distal-segment lengths were 95.4% and 93.0%, respectively, of the contralateral finger. Average TAM and ROM of the thumb-IP or finger-DIP joints were 92.0% and 83.0% of normal, respectively. Semmes-Weinstein results were blue (3.22 to 3.61) in 4 fingers and purple (3.84 to 4.31) in 8; the mean result from the 2-point discrimination test was 5.9 mm (range, 3 to 11 mm). Thus, amputated fingertips should be aggressively replanted.