Hand Surgeons Report on Fingertip Amputation and Replantation
Have you ever nearly cut the tip of your finger off and thought that was a close one? Some folks aren't so lucky and face the decision of whether to accept the amputation or try for replantation of the finger tip. Hand surgeons say this is a challenging procedure with many pitfalls.

In this article, two hand surgeons from the Christine M. Kleinert Institute for Hand and Microsurgery in Louisville, Kentucky describe and illustrate this surgical procedure called distal finger replantation.

They suggest the procedure is not possible when the injury involves crushing or contamination. But for children, young women, musicians, or others who truly need the tip of the finger, distal finger replantation should be attempted.

What makes this procedure so technically challenging? You wouldn't necessarily know it to look at the tip of the finger but the anatomy is incredibly complex. There are multiple pulleys that make it possible for the finger to bend.

A network of arteries, veins, ligaments, fascia (connective tissue), and an elaborate lymphatic (fluid drainage) system are all contained within the finger. All of the structures are tiny and their locations are not exactly the same from person-to-person.

Replantation calls for a microvascular surgeon who uses a high-power microscope to repair blood vessels. Unless blood vessels and nerves are matched up and reconnected properly, loss of sensation and temperature control can occur.

To aid surgeons in understanding tip recovery and restoration, detailed drawings of the finger and fingertip anatomy are provided. X-rays, photos of damaged fingers (before, during and after surgery), and drawings aid in demonstrating surgical techniques for replantation.

Special consideration must be given when the fingernail has been damaged. In children, the surgeon must assess whether the amputation injury has gone through the growth plate of the bone. Any joint damage must also be considered. Skin grafts may be needed if too much skin must be removed or has been destroyed by the injury.

There are many possible complications following distal finger replantation. Blood clots can form cutting off circulation to the healing area and/or traveling to the heart or brain. The reattached tip of the finger may not survive. There is a risk of infection but modern day antibiotics often prevent that from happening.

The authors conclude by saying that the cosmetic effect of replantation is preferred by most people. Full function of the finger is not possible without the tip but this may not be as important for a manual laborer as for a musician. Amputation without replantation can lead to the development of painful neuromas (growth or tumor of nerve tissue).
Luis R. Scheker, MD, and Giles W. Becker, MB BChir. Distal Finger Replantation. In The Journal of Hand Surgery. March 2011. Vol. 36A. No. 3. Pp. 521-528.