Fingertip Amputations & Finger Flaps - Hand (2024)

Updated: Apr 14 2023

  • 8
Mark Karadsheh MD

Fingertip Amputations & Finger Flaps - Hand (1)

Fingertip Amputations & Finger Flaps - Hand (2)

Fingertip Amputations & Finger Flaps - Hand (3)

Fingertip Amputations & Finger Flaps - Hand (4)

Introduction
  • Injury to the finger with variable involvement of soft tissue, bone, and tendon
  • Goals of treatment
    • sensate tip
    • durable tip
    • bone support for nail growth
  • Prognosis
    • improper treatment may result in stiffness and long-term functional loss
Anatomy
  • Fingertip anatomy
    • eponychium
      • soft tissue on the dorsal surface just proximal to the nail
    • paronychium
      • lateral nail folds
    • hyponychium
      • plug of keratinous material situated beneath the distal edge of the nail where the nail bed meets the skin
    • lunula
      • white portion of the proximal nail
      • demarcates the sterile from germinal matrix beneath
    • nail bed
      • sterile matrix
        • where the nail adheres to the nail bed
      • germinal matrix
        • proximal to the sterile matrix
        • responsible for 90% of nail growth
Presentation
  • History
    • mechanism
      • avulsion
      • laceration
      • crush
  • Physical exam
    • inspection
      • often, characteristics of laceration will guide management
      • presence or absence of exposed bone
    • range of motion
      • flexor and extensor tendon involvement
Imaging
  • Radiographs
    • required imaging
      • AP/lateral radiographs to assess for bony involvement
Treatment
  • Nonoperative
    • healing by secondary intention
      • indications
        • adults and children with no bone or tendon exposed with < 2cm of skin loss
        • children with exposed bone
  • Operative
    • primary closure (revision amputation)
      • indications
        • finger amputation with exposed bone and the ability to rongeur bone proximally without compromising bony support to nail bed
    • full thickness skin grafting from hypothenar region
      • indications
        • fingertip amputation with no exposed bone and > 2cm of tissue loss
    • flap reconstruction
      • indications
        • exposed bone or tendon where rongeuring bone proximally is not an option
Surgical Techniques
  • Secondary intention
    • technique
      • initial treatment with irrigation and soft dressing
      • after 7-10 days, soaks in water-peroxide solution daily followed by application of soft dressing and fingertip protector
      • complete healing takes 3-5 weeks
  • Full thickness skin grafting from hypothenar region
    • technique
      • split thickness grafts not used because they are
        • contractile
        • tender
        • less durable
      • donor site is closed primarily
      • graft is sutured over defect
      • cotton ball secured over graft helps maintain coaptation with underlying tissue
    • post-operative care
      • cotton ball removed after 7 days
      • range of motion encouraged after 7 days
  • Primary closure with removal of exposed bone (revision amputation)
    • technique
      • must ablate remaining nail matrix
        • prevents formation of irritating nail remnants
      • if flexor or extensor tendon insertions cannot be preserve, disarticulate DIP joint
      • transect digital nerves and remaining tendons as proximal as possible
      • palmar skin is brought over bone and sutured to dorsal skin
  • Flap reconstruction (see below)
Flap Techniques By Region
  • Flap treatment options determined by location of lesion

Fingertip Amputations & Finger Flaps - Hand (10)

1.Finger Tip
Straight or Dorsal Oblique laceration
V-Y Advancement flap
Digital island artery
Volar Oblique laceration
Cross finger flap(if > 30 yrs)
Thenar flap (if< 30 yrs)
• Digital island artery
  • reverse cross finger (for nail bed sterile matrix and eponychial fold losses)
2.Volar Proximal Finger
Cross finger (if > 30 yrs)

• Axial flag flap from long finger
3.Dorsal Proximal Finger & MCP
Reverse cross finger
• Axial flag flap from long finger
4.Volar Thumb
Moberg AdvancementVolar Flap (if < 2 cm)

• FDMA (if > 2 cm)
• Neurovascular Island Flap (up to 4 cm)
5.Dorsal Thumb
First Dorsal Metacarpal Artery (FDMA) flap
6.First Web Space
Z-plasty with 60 degree flaps
Posterior interosseous fasciocutaneous flap(if > 75%)
7.Dorsal Hand
Groin Flap
Flap Reconstruction Techniques
  • V-Y advancement flap
    • indications
      • straight or dorsal oblique finger tip lacerations
  • Digital island artery
    • indications
      • straight or dorsal oblique finger tip lacerations
      • volar oblique finger tip lacerations
    • advantages
      • best axial pattern flap
  • Cross finger flap
    • indications
      • volar oblique finger tip lacerations in patients > 30 years
    • advantages
      • leads to less stiffness
  • Reverse cross finger flap
    • indications
      • dorsal finger & MCP lacerations
  • Thenar flap
    • indications
      • volar oblique finger tip lacerations to index or middle finger in patients < 30 years
    • advantages
      • improved cosmesis
  • Axial flag flap from long finger
    • indications
      • volar proximal finger
      • dorsal proximal finger & MCP lacerations
  • Moberg advancement volar flap
    • indications
      • volar thumb if < 2 cm
  • Neurovascular island flap
    • indications
      • volar thumb up to 4 cm
  • First dorsal metacarpal artery flap
    • indications
      • dorsal thumb lacerations
      • volar thumb lacerations if> 2 cm
    • technique
      • based on 1st dorsal metacarpal artery
  • Z-plasty with 60 degrees flaps
    • indications
      • first web space lacerations
    • technique
      • can lead up to75% increase in length
  • Posterior interosseous fasciocutaneous flap
    • indications
      • first web space lacerations
  • Groin flap
    • indications
      • lesions to dorsal hand
Complications
  • Flap failure
    • cause
      • inadequate arterial flow
        • vasospasm often leads to thombosis at anastamosis
      • inadequate venous outflow
  • Hook nail deformity
    • cause
      • tight tip closure
      • insufficient bony support
    • treatment
      • variety of reconstructive procedures have been described

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FAQs

Is an amputated fingertip a disability? ›

A traumatic amputation is the loss of a body part—usually a finger, toe, arm, or leg—that occurs as the result of an accident or trauma. An amputation is considered a disabling condition by the Social Security Administration (SSA) and may qualify you for SSD benefits.

How long does a flap cut on your finger take to heal? ›

Most wounds will heal within 2-4 weeks. The time that these take to heal depends on the size of the affected area.

What is the outcome score for fingertip injuries? ›

The mean follow-up of our study was 26.8 months (range, 18–66 months). We classified the results based on the FIOS. A value of 12 or more is considered excellent; 13–18 is good; 19–24 is fair; and greater than 24 is poor.

What happens if you lose the tip of your finger? ›

After thoroughly cleaning and preparing an amputated fingertip, the surgeon may reattach it to the finger. The fingertip may continue to grow relatively normally, even if bone was exposed. This is especially possible in children younger than 2 years of age.

What should you not do with an amputated finger? ›

If you have a severed finger or fingers:
  • Don't remove any jewelry or clothing from the finger.
  • Gently wash off the amputated finger with water or sterile saline – don't scrub it.
  • Cover the finger in a damp, gauze wrap.
  • Put the finger in a clean waterproof bag.
Nov 2, 2018

How common are fingertip amputations? ›

Thousands of people suffer from devastating hand injuries every year, often leading to fingertip amputations. It is estimated that as many as 45,000 finger amputations are performed in the US per year with an incidence rate of 7.5/100,000 people [1,2].

What are the different grades of finger tip injuries? ›

Type I-loss of only the pulp of the finger; 2. type II, pulp and nail loss without bone fragment in the distal amputated fingertip; 3. type III, partial loss of the distal phalanx plus corresponding loss of the pulp and nail; 4. type IV, loss proximal to the germinal matrix.

Will I get feeling back in my finger after a cut? ›

Nerves: Sensory nerves in the fingertip are very small and are usually too small to repair surgically. Numbness, tingling, and hypersensitivity are common after a fingertip injury. In most patients, however, the nerve endings regenerate and the sensation improves gradually over time.

Will a finger pad grow back? ›

When a kid lops off a fingertip with a cleaver or car door, there's a chance the end of the digit will grow back. The fingerprint will be gone, and the tip may look a bit strange. But the flesh, bone and nail could return.

Is losing a finger life changing? ›

Emotional Recovery

Losing an arm, hand, finger or other body part can be traumatizing and may change your life drastically. It can be hard to accept these changes, which is why visiting a counselor, talking to your doctor, or communicating with other amputees can be important to a full recovery after an amputation.

What is the least important finger to lose? ›

To summarize: the first finger on the hand you don't use for writing is the least important finger, and the fourth toe on the foot you don't use to kick a soccer ball is probably your least important toe.

Which finger is most commonly lost? ›

"I would bet you there are hundreds of those for every amputated tip," he said. The researchers found that the index and middle fingers were the most likely to be injured, and that more than half of the injuries occurred at home.

Can you get disability if you lose a finger? ›

Many amputees are able to regain lost mobility with the help of prosthetics and other assistive devices, allowing them to perform some kind of employment. The only way to collect Social Security disability benefits for amputation is if the condition makes it impossible for the amputee to earn a regular income.

What are the classification of finger tip injuries? ›

Type I-loss of only the pulp of the finger; 2. type II, pulp and nail loss without bone fragment in the distal amputated fingertip; 3. type III, partial loss of the distal phalanx plus corresponding loss of the pulp and nail; 4. type IV, loss proximal to the germinal matrix.

What percentage of disability is a finger? ›

The loss of a little or fourth finger shall be considered a five percent disability. The loss of ring or third finger (one phalanx) shall be considered a three percent disability.

What qualifies as a hand disability? ›

Fine motor disability is an inability or impairment of an individual to perform tasks that require a degree of manual dexterity. Fine motor ability is usually synonymous within the literature concerning the ability of an individual to make precise, voluntary, and coordinated movements with their hands.

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