Salvage of fingertip amputated at nail level: new surgical principles and treatments
Research article published in Annals of plastic surgery (1997)
Abstract
In this study, a new classification of fingertip amputation based on the surgical treatment is reported. Specifically, the necessity for special procedures to prevent venous congestion in fingertip replantation at the nail bed level was studied. There are some reports of successful replantations without venous anastomoses. In order to avoid technical factors, clinical cases operated on by a single surgeon were evaluated to determine what treatment is necessary for amputations at various levels to avoid necrosis due to venous congestion. During the 5-year period from October 1987 to October 1992, 150 replantations in 137 patients were performed, including 49 fingertip replantations in 45 patients who were operated on consecutively by a single surgeon. The distal phalanx (DP) of the finger was classified as zone DP-I, IIA, IIB, and III from distal to proximal. This classification was based not only on the amputation level but also on the difference in surgical treatment. For amputations of zone DP-I, which extends from the fingertip to the most distal dividing point of the digital artery, the amputated fingertip is attached without vascular anastomosis and the whole finger is wrapped in aluminium foil and cooled in ice water for 3 days. For amputations of zone DP-IIA and IIB, anastomosis of the digital artery is performed in the central portion of the palmar region of the finger, but Kirschner wire fixation is not performed so as not to disturb the venous drainage through the medullary cavity. For amputations of zone DP-IIA, special treatment is not necessary for venous congestion, and for those of zone DP-IIB partial resection of the nail is done if necessary. For zone DP-II amputations, venous anastomosis must be performed for salvage. All patients were operated on according to the procedures based on this classification and final survival rate was 91.5%.
Abstract sourced from PubMed (NCBI) for the cited record. See the original publication for the authoritative version.
Summary
Peer-reviewed clinical and outcomes research relevant to medicinal leech therapy and its biology. Indexed in PubMed and verified against the NCBI record.
Why This Matters for Hirudotherapy
This single-surgeon case series of 49 consecutive fingertip replantations (within 150 replantations over five years) proposed a distal-phalanx zone classification keyed to surgical treatment and centered on preventing venous congestion, reporting a 91.5% overall survival rate, with the most distal zone managed by attaching the fingertip without vascular anastomosis and cooling, and more proximal zones requiring arterial or venous anastomosis. This is among the more directly pertinent records for hirudotherapy, since venous congestion in distal replantation, where adequate venous outflow cannot be surgically restored, is the classic indication for medicinal-leech therapy to decompress the congested tissue. Honest caveat: this is a 1997 case series describing one surgeon's classification and technique and does not itself study or quantify leech therapy; it illustrates the clinical problem leeches are used to address rather than providing trial-level evidence for them.
Citation
Salvage of fingertip amputated at nail level: new surgical principles and treatments.
Hirase · Annals of plastic surgery, 1997
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