Mechanisms and management of fingertip amputations in a teaching hospital, South-South, Nigeria

Abstract

Injuries to the fingertip are common in our Accident and Emergency Department. The goal of treatment is restoration of a painless, functional digit with protective sensation. In other words, it involves the provision of sensate and durable fingertip and bone support for nail growth. When selecting a treatment option the amount of soft-tissue loss, the integrity of the nail bed, the age and physical demands of the patient should be considered. The study seeks to evaluate the mechanisms and management of fingertip amputations including the treatment modalities used and its impact on patient outcomes. This is a prospective study of 37 patients with 43 cases of fingertip amputations. Patient ages ranged from 5 to 56 years. Data was collected from January, 2016 to December, 2017. Various reconstructive options were considered for the fingertip amputations such as skin grafting, cross finger flap, thenar flap, hypothenar flap, louvers flap and groin flap in multiple digital injuries. The total duration of treatment varied from two to seven weeks with follow-up of two to eight months. The results showed preservation of finger length and contour, retention of sensation and healing minimal complication. About 40% of the patients had well formed fingertip pulps which were aesthetically acceptable. In conclusion, fingertip amputation is a common injury. Treatment depends on how much skin, soft tissue, bone and nail were damaged and how much of the finger or thumb was cut off. A good knowledge of the mechanism of injury, type of injury, occupation of patient and hand dominance would help in deciding the surgical technique to use. A satisfactory reconstruction is ascertained if the patient has durable, sensate, fingertip length preservation and a fairly formed pulp.