Eshealthtips.com – Amputation of the distal phalanx (the finger on which your thumb rests) can cause a severe nerve injury. In such cases, it is often necessary to reconstruct a portion of your finger using a skin flap. Several surgical techniques exist to reconstruct this section of the finger. A trans digital flap is one of these techniques, using the dorsal skin and subcutaneous tissue of the donor’s finger. The skin flap is then raised from the middle phalanx and competes with the damaged digital nerve stump.
Traumatic Amputation of Right Thumb
A sixty-year-old farmer presented with a traumatic amputation of his right thumb. A deep, circumferential wound at the base of his thumb had fractured the distal phalanx, causing it to hang by the volar skin only. Direct loose skin closure was performed to stabilize the stump. One week after the amputation, the patient developed a superficial wound infection. He was prescribed oral antibiotics for four weeks.
In most cases, the distal phalanx is amputated after a tendon has been severed. Fingertip amputation requires definitive operative care by a hand surgeon, whose goals are the reduction of pain, restoration of sensation, and bony support for nail growth. Occasionally, re-implantation of an amputated fingertip may be attempted; however, the success rate is very low. Nevertheless, if this option is available, the patient should be assured that re-implantation will result in the most functional restoration possible.
Accurate Diagnosis and Proper Treatment
In some cases, the distal phalanx amputation is functional. Moreover, the remaining middle phalanx is lost to flexion control. To improve flexion control, disarticulation at the proximal interphalangeal joint is performed. The ring and long fingers are often improved after ray resection. However, the amputation leaves a large space in the center of the hand, which cannot be closed with a prosthesis.
The most common site of amputation is the phalanx, and the most commonly injured part in children is the finger. A distal phalanx amputation may not be necessary in every case, but an accurate diagnosis and timely treatment are important in most cases. A physician should always follow the guidelines outlined by the American Academy of Pediatrics. There is no standardized way to perform this procedure. However, if you have a patient who has suffered from this condition, you should consult a board-certified surgeon immediately.
Patient Must Be Monitored During Procedure
The patient should be monitored during the procedure. The flap should be checked for color and capillary refill. The patient may require conscious sedation for more extensive debridement. Midazolam may be used to achieve conscious sedation. A tourniquet is also recommended to keep the area in a moist environment. Often, a protective splint is helpful. When a patient undergoes a distal phalanx amputation, they should be evaluated by a physician to ensure proper healing.
The patient should be monitored during the procedure. The flap should be checked for color and capillary refill. Patients may require conscious sedation for more extensive debridement. Midazolam can be used to achieve conscious sedation. A tourniquet is also recommended to keep the area in a humid environment. Often, a protective splint is helpful. When a patient undergoes a distal phalanx amputation, they should be evaluated by a doctor to ensure proper healing.
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