Chapter 31 KEY FIGURESAmputation of the middle finger 304Practical Plastic Surgery for Nonsurgeons If enough skin is available close the wound with a few loose sutures Atight closure can lead to fu ID: 313098
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TRRAAUUMMAATTIICC HHAANNDDAANNDDFFIINNGGEERRAAMMPPUUTTAATTIIOONNSSThis chapter outlines the basic principles for the evaluation and treatmentof traumatic hand and finger amputations proximal to the distal inter-phalangeal (DIP) joint. Amputations distal to the DIPjoint can be treatedThe procedure to reattach an amputated part is highly technical and te-dious. It includes reconnecting blood vessels (both an artery and atleast one vein), nerves, and lacerated tendons as well as realigning andstabilizing the bones. Ahighly trained microsurgeon with access tospecialized equipment is required.Your best strategy is to help the wound heal with as little functionaldisability as possible. You can take steps to prevent, for example, apainful stump, which will interfere with use of the hand.the amputated part (see chapter 6, Evaluation of an Acute Wound).off so that the ends of the tendons are covered by soft tissue.Do not discard the amputated part until you have thoroughly exam-ined the wound. You may be able to use some of the skin from the am- Chapter 31 KEY FIGURES:Amputation of the middle finger 304Practical Plastic Surgery for Nonsurgeons If enough skin is available, close the wound with a few loose sutures. Atight closure can lead to further tissue loss.If no skin is available, no bone or tendon is exposed, and the wound isrelatively small ()eated withlocal care. An alternative is to use noninjured skin from the amputatedIf the wound is large and cannot be closed primarily or if bones orintact tendons are exposed, a distant flap (e.g., chest flap, groin flap) isneeded for wound closure. (See chapter 14, Distant Flaps.)nerve and pull gently. Then cut the nerve back to the point where itexits the soft tissues. This maneuver allows the nerve to retract underhealthy skin or soft tissue and thus prevents development of a sensi-Clean with gentle soap and water or sterile saline daily. Strongly urge the patient not to smoke. The patient should keep the affected hand elevated to decreaseswelling and pain and to promote healing.Remember pain medication. Acetaminophen alone may not be enoughfor the first few days after injury. Amputations can be quite painful.Apply antibiotic ointment and a simple, dry dressing 1 2 times/day.Wet-to-dry dressings also can be useful.If the wound was sutured closed, after a few days the dressings canIf the wound was left open, continue the dressing changes until theEncourage the patient to move the finger and hand to prevent jointstiffness. Active and passive range-of-motion exercises also should beIff aa PPrrooppeerrllyy EEqquuiippppeedd MMiiccrroossuurrggeeoonn iiss AAvvaaiillaabblleeYou can take several important steps before the patient is transferred tothe microsurgeons care. An amputated hand or finger(s) can be re-planted even many hours after the injury, but the amputated part mustreceive proper care. 306Practical Plastic Surgery for Nonsurgeons Care of the amputated segment. The am-tainer. (From McCarthy J (ed): PlasticSurgery. Philadelphia, W.B. Saunders,1990,with Traumatic amputation of the middle finger. Hand with missing finger. One year after successful replantation. A, Patient has regained excellentfunction of her hand.