During his/her daily profession, one is at risk – no matter how small – of getting an accident. One of the accidents that can happen is a fingertip injury. This can happen to a chef in a restaurant, a factory employee working with heavy machinery, and many other occupations. The affected fingertip can be separated entirely (complete amputation) or still attached to some degree by a strand of tissue (partial amputation).
The bleeding that occurs on the finger stump can be stopped easily with a light compression using bandage or clean cloth. The amputated fingertip should be cleaned from debris using flowing water. Next, wrap it with dry bandage and seal it inside a clean and dry plastic bag. Do not soak the amputated fingertip in water. The plastic bag containing the amputated fingertip is then put inside a second plastic bag filled with ice cubes and water. The purpose of this “two package technique” is to prevent further contamination and mechanical damage to the amputated fingertip. The cooling (ideally at 40C) is aimed to suppress the rate of cell death. The victim should be transported to the nearest hospital as soon as possible.
An amputation caused by a sharp trauma (clean cut) is more likely to be reattached successfully compared to that of a blunt trauma. A sharp trauma is caused, for example, by a knife. An example of a blunt trauma, on the other hand, is when a finger gets caught in the rotating parts of a machine. An accompanying crush injury in a blunt trauma makes the future outcome even worse.
Microsurgery is a surgery technique done with the aid of a microscope to operate on tissues which are otherwise too small to be seen with naked eyes. With this technique, a surgeon trained in microsurgery can reattach microscopic blood vessels and nerves. The reattachment process is called replantation (for complete amputation) or revascularization (for partial amputation). On infants, reattachment procedure can be done without blood vessel rejoining via microsurgery due to their excellent regeneration capability. This is not true for adults, on whom the success rate is unclear.
In cases where reattachment is not possible, the management of the finger stump can be done by closure using skin graft, composite graft, or flaps.
- Skin grafting is a technique where a thin piece of skin is utilized to cover the wound on the finger stump. The donor skin can be taken from the palm or feet sole of the patient. After being placed on the wound bed, the donor skin is expected to survive on nutrition and oxygen from blood seepage of the wound bed.
- A composite graft is a graft consisting of deeper layers than skin graft, i.e. the fat tissue under the skin, making it thicker than skin graft. The purpose of this method is to recover more finger length and achieve better aesthetic result. However, because thicker tissue needs more nutrition and oxygen supply, the success rate is lower than the skin graft method.
- Flap reconstruction is more reliable in terms of tissue survival. A specific area of tissue is removed but a strand of tissue still connects the donor to the donor bed to supply nutrition. The flap can originate from the wounded finger itself, an adjacent finger, the palm, chest, or even the abdomen. The flap is left attached to the donor – usually for 3 weeks – until the flap can survive on its own. By microsurgical technique, this composite tissue known as flap can be transferred freely from other part to cover the injured finger. Then the transferred tissue carrying blood vessels is to be reconnected with the vessels in the injured finger. More on microvascular reconstruction in fingertip injuries is available here.
(© Teddy O.H. Prasetyono, 2012)