Immediate Microsurgical Reconstruction of Fingertip Injuries

ABSTRACT

During the recent 8 years, 45 fingertip injuries were reconstructed with immediate microsurgical free flap in 36 patients. There were 21 patients of pulp reconstruction (great toe pulp flap 8 cases, pulp flap from the second toe 3 cases, innervated arterialized venous flap 5 cases and first web space flap 5 cases) for pulp defect proximal to the most distal palmar crease of the fingers, 5 cases of onychocutaneous flap for thumb nail reconstruction, and 10 cases of partial toe transfer(partial great toe transfer 8 cases and second toe wrap-around procedure 2 cases). Overall survival rate of flap transfer was 97.2%(35/36). The static 2-point discrimination averaged 8 mm in pulp reconstruction of the thumb, 12 mm in index and 16 mm for other fingertip reconstruction. There was 1-2 mm atrophy of the nail width after onychocutaneous flap for thumb nail reconstruction. The subjective satisfaction of self-assessment score on the new fingertip was 85 and 88 of the thumb reconstruction in function and appearance, respectively. The score of the index was higher than that of other fingers. Immediate microsurgical reconstruction of the fingertip injuries provides many advantages over other procedures such as single stage reconstruction, early exercise and shortened convalescent period, and high satisfaction score by self-assessment in both functional and aesthetic aspects. Therefore, immediate microsurgical reconstruction of fingertip injury is a safe and reliable procedure in case of limited indications.