AI Article Synopsis
- - The study examines the challenges and outcomes of replanting amputated fingertips caused by motorcycle spoke injuries, focusing on Allen's type III and IV amputations, which often involve significant damage to the fingertip pulp.
- - Forty patients were treated using a surgical method that repositions the amputated stump with local pedicle flaps, and the results were analyzed over an average follow-up of about 24 months, measuring factors like movement range, sensation, and return to work.
- - Findings showed that this surgical approach is safe and effective, allowing all patients to return to work in about 13 weeks with good functional outcomes, while minimizing complications like finger stiffness and maintaining satisfactory sensation.
Article Abstract
Purpose And Background: Replantation of the distal fingertip amputation poses a technical challenge to the treating hand surgeon especially dealing with motorcycle spokes wheel injury causing Allen's type III and IV amputation. The reason being the pulp charred and severely crushed. Various reconstructive options have been described in the literature. We analyze the surgical option of repositioning the amputated stump with local pedicle flaps in such injuries and interpreting the results and functional outcome.
Methods: Forty patients with motorcycle spokes wheel fingertip amputations involving thumb (60%) and index, middle, and ring fingers were operated by reposition flap between 2017 and 2019. Group I was Allen's type III amputations (n = 20). Group II was type IV amputations (n = 20). Range of movements, 2-point discrimination, sensation, intolerance to cold, nail aesthetics outcome, VAS, quick DASH score and return to work were analyzed in these two groups and evaluated.
Results: The average follow-up of our study in group I and group II was 24.6 and 24.4 months, respectively. All patients returned to work in an average of 13.4 weeks with a good radiological bone union and an excellent range of movements. All had an average 2-point discrimination of 8.5 mm and 8.3 mm; VAS as 0.2, mean quick DASH score 5.4 and 5.0, respectively in both groups. 15% dysplastic nail and 30% had cold intolerance; all had satisfactory sensation in the final follow-up with an average finger shortening of 4.7 and 5 mm. No finger stiffness and donor site morbidity seen.
Conclusions: Reposition of the amputated distal phalanx, free nailbed graft with cross finger flap in motorcycle spokes wheel injury is safe, and effective. It preserves the pulp contour and gives a good functional outcome. It is a viable alternative option to replantation in Allen's type III and IV fingertip amputations especially in motorcycle spokes wheel injury with pulp loss.
Level Of Evidence: IV.
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Source |
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| http://dx.doi.org/10.1007/s00068-020-01462-6 | DOI Listing |
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