Revascularization Index Finger
Replantation/revascularization of severely injured single digits is controversial, especially at the index position. Conventional wisdom is that these digits if salvaged will ultimately worsen residual hand function and they should be amputated. Twenty-eight cases of such index salvages were reviewed to test this hypothesis. Five cases involved children and were excluded. Twenty-three replants/revascularizations survived (100%). Total active motion was 170 degrees in zone 1, and 133 degrees for zone 2 injuries. Patient satisfaction was high in all cases. In selected cases, salvage of severely injured and amputated index fingers has the potential for satisfying survival and functional results and dogmatic treatment with completion amputation should be avoided. Microsurgery. 2008;28(8):612-6.
This patient sustained a near complete amputation of an isolated index finger from a circular saw. The digit was devscularized only attached by a dorsal skin bring and the patient choose to attempt salvage.
X-ray revealing that the bony level of the injury occurred at the neck of the proximal phalanx.
First bony stabilization was obtained with K-wire fixation. Repair of the flexor and extensor tendons was performed.
Microsurgical repair of arterial supply was performed revealing good capillary refill of the traumatized digit.
Healing bone and a non tender fracture site allows removal of the K-wires.
Early post operative extension is good.
Full flexion has been obtained.
Strengthening in a happy patient who has undergone successful revascularization of a digit for which some authors have recommended completion amputation.