Tamai Zone 1 Fingertip Amputation: Reconstruction Using a Digital Artery Flap Compared With Microsurgical Replantation

Abstract

Purpose: The surgical treatment of fingertip amputations is controversial. This study was designed to compare the clinical results of 2 surgical procedures for fingertip amputation: reconstruction with a digital artery flap and microsurgical replantation.

Methods: Between 2003 and 2015, 37 patients with Tamai zone 1 fingertip amputation of the index or middle finger were treated by reconstruction with a digital artery flap (n = 23) or microsurgical replantation (n = 14). Data for these patients were evaluated retrospectively. Nerve suture was not conducted in microsurgical replantation because spontaneous sensory recovery is expected in zone 1 replantation. Primary outcomes included hand dexterity (Purdue Pegboard Test), and disability of the upper extremity (Disabilities of the Arm, Shoulder, and Hand score). Secondary outcomes included strength (key pinch), digital sensitivity (Semmes-Weinstein test), and finger mobility (% total active motion).

Results: The average follow-up period was 34 months. There was no significant difference in the primary outcomes between the 2 groups. The reconstruction group showed significantly better results for the secondary outcomes.

Conclusions: This study suggests that the 2 procedures were comparable regarding postoperative activities of daily living and hand performance, but reconstruction using a digital artery flap gave better objective functional outcomes than microsurgical replantation.

Type of study/level of evidence: Therapeutic IV.

Keywords: Digital artery flap; finger function; fingertip amputation; replantation.