Non-microsurgical “replantation” of Allen’s type III amputation: combined distal phalangeal fixation and nail bed suture with V-Y volar advancement flap

To describe our technique, namely, combined distal phalangeal fixation and nail bed repair with a V-Y volar advancement flap for Allen type III fingertip amputation.

The clinical data of 16 patients (18 fingers) with Allen type III fingertip amputation who underwent this procedure were retrospectively studied. Distal phalangeal fixation and nail bed repair were performed first to transform the injury into a pulp defect, and then the volar V‒Y flap was applied to cover the defect. Postoperatively, humectant was applied to moisten the nail but no lamp heating was applied. The main indicators were patient self-reported appearance and daily use, static two-point discrimination, range of distal interphalangeal joint motion (range of DIPJ motion), complications and the Chinese Medical Association upper limb function evaluation trial standard for severed fingers (CMA evaluation).

The average follow-up time was 14.3 months. All 18 fingertips survived. One patient underwent a secondary surgery due to infection resulting in exposure of the bone of the fingertip. One patient developed a hooked nail. The appearance and daily use of the fingertip were satisfactory or acceptable for all the patients except for those who experienced the above two complications. After one year, the mean static two-point discrimination was 3.8 mm (range 2.5–4.6 mm). The range of DIPJ motion of the affected fingers was 90.7% of that of the unaffected side. According to the CMA evaluation, 13, 3 and 2 fingers showed excellent, good and average results, respectively.

The combination of distal phalangeal fixation and nail bed suturing with a V-Y volar advancement flap is worthy of clinical application for Allen type III fingertip amputation. The technique is simple and straightforward.

Level III, Therapeutic study.