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Fingertip injuries and replantation
A small fingertip defect without exposed bone heals on its own, a defect with exposed bone is covered by a local flap, and an amputated part is replanted when functional benefit is expected — thumb, multiple digits, the hand, any amputation in a child and a single digit distal to the FDS insertion.
Why it matters in the exam
A fingertip defect smaller than about 1 square centimetre without exposed bone heals well by secondary intention and gives good sensation. With exposed bone the flap is chosen by the direction of the cut: palmar V-Y (Atasoy) for a transverse or dorsal cut, lateral V-Y (Kutler); Moberg — a palmar advancement flap for the thumb; cross-finger — skin from the dorsum of the middle phalanx of the neighbouring finger for a palmar defect, divided after 2 to 3 weeks; a thenar flap for fingers; the Littler flap — a neurovascular island from the ulnar side of the middle or ring finger to reconstruct a sensate thumb pulp; and the kite flap on the first dorsal metacarpal artery for the dorsum of the thumb.
Indications for replantation: thumb, multiple digits, hand or wrist, any part in a child, and a single digit amputated distal to the FDS insertion (zone 1), where the functional result is good. Relative contraindications: a single digit in zone 2 (between the FDS insertion and the palm) — because the finger stays stiff and impairs the hand — severe crush or avulsion, multilevel injury, long ischaemia time and severe comorbidity. Accepted ischaemia times: digit — 12 hours warm and 24 cold; a part with muscle — 6 hours warm and 12 cold. Correct transport: wrap the amputated part in saline-moistened gauze, put it in a sealed bag and place the bag on ice — do not immerse it and do not place it directly on ice. The usual order of repair: bone, extensor tendons, flexor tendons, arteries, nerves, veins and skin. After surgery: warmth, no smoking, monitoring of colour and capillary refill.
Key points
- Small defect without bone — secondary healing.
- Exposed bone — V-Y, Moberg, cross-finger, Littler.
- Replant: thumb, multiple, hand, child, zone 1.
- Digit: 12 hours warm, 24 cold.
- Transport: moist gauze, bag, ice outside the bag.
Summary table
| Situation | Solution | Key detail |
|---|---|---|
| Defect under 1 square centimetre without bone | Secondary healing | Good sensation |
| Exposed bone, transverse cut | Palmar V-Y (Atasoy) | Also lateral (Kutler) |
| Thumb pulp defect | Moberg or Littler | Littler — sensate pulp |
| Palmar defect of a finger | Cross-finger | Divide after 2 to 3 weeks |
| Amputation | Replant by indication | Thumb, multiple, child, zone 1 |
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Sources
- American Society for Surgery of the Hand: Hand Surgery Update, current edition — Fingertip injuries; Replantation
- Green's Operative Hand Surgery, 8th edition (2022) — Replantation; Fingertip injuries and local flaps
- British Society for Surgery of the Hand standards for hand trauma (BSSH), 2016 — Referral and timing
Sources are given for further reading; the text is written afresh and not copied from them.
Reviewed by the Examqo AI Professor · 2026-11-06. The text may contain errors; when in doubt, check the source.