Fingertip amputations are one of the most common injuries faced in an emergency department. Finger tip replantation though technically possible, are not regularly done due to the presumed complexity of the procedure and doubts about the outcome. This article deals with our experience of 24 fingertip replantations in 24 patients done over a period of 8 years since the year 2000. Twenty-one fingertips survived. The most common affected digit in the series was thumb followed by index, middle, and ring. The overall success rate was 87%. Both arterial and venous repair were done in all cases. Replantation was not done if no suitable vein was found for anastomosis. Nine patients did not have nerve repair. Seven of them survived and all of them had satisfactory sensation when examined after 1 year. No patient suffered from cold intolerance. All patients were satisfied with the functional outcome and aesthetic appearance. This article highlights the technical considerations and the outcome of these fingertip replants.

Background:Epidemiological studies on traumatic brachial plexus injuries are few and these studies help us to improve the treatment, rehabilitation of these patients and to allocate the resources required in their management. Epidemiological factors can vary in different countries. We wanted to know the situation in an Indian centre.Materials and Methods:Data regarding age, sex, affected side, mode of injury, distribution of paralysis, associated injuries, pain at the time of presentation and the index procedure they underwent were collected from 304 patients. Additional data like the vehicle associated during the accident, speed of the vehicle during the accident, employment status and integration into the family were collected in 144 patients out of the 304 patients.Results:Road traffic accidents accounted for 94% of patients and of the road traffic accidents 90% involved two wheelers. Brachial plexus injury formed a part of multitrauma in 54% of this study group and 46% had isolated brachial plexus injury. Associated injuries like fractures, vascular injuries and head injuries are much less probably due to the lower velocity of the vehicles compared to the western world. The average time interval from the date of injury to exploration of the brachial plexus was 127 days and 124 (40.78%) patients presented to us within this duration. Fifty-seven per cent had joined back to work by an average of 8.6 months. It took an average of 6.8 months for the global brachial plexus-injured patients to write in their non-dominant hand.

BackgroundPurpose of this study was to evaluate the functional outcome of spinal accessory to suprascapular nerve transfer (XI-SSN) done for restoration of shoulder function and partial transfer of ulnar nerve to the motor branch to the biceps muscle for the recovery of elbow flexion (Oberlin transfer).MethodsThis is a prospective study involving 15 consecutive cases of upper plexus injury seen between January 2004 and December 2005. The average age of patients was 35.6 yrs (15–52 yrs). The injury-surgery interval was between 2–6 months. All underwent XI-SSN and Oberlin nerve transfer. The coaptation was done close to the biceps muscle to ensure early recovery. The average follow up was 15 months (range 12–36 months). The functional outcome was assessed by measuring range of movements and also on the grading scale proposed by Narakas for shoulder function and Waikakul for elbow function.ResultsGood/Excellent results were seen in 13/15 patients with respect to elbow function and 8/15 for shoulder function. The time required for the first sign of clinical reinnervation of biceps was 3 months 9 days (range 1 month 25 days to 4 months) and for the recovery of antigravity elbow flexion was 5 months (range 3 1/2 months to 8 months). 13 had M4 and two M3 power. On evaluating shoulder function 8/15 regained active abduction, five had M3 and three M4 shoulder abduction. The average range of abduction in these eight patients was 66 degrees (range 45–90). Eight had recovered active external rotation, average 44 degrees (range 15–95). The motor recovery of external rotation was M3 in 5 and M4 in 3. 7/15 had no active abduction/external rotation, but they felt that their shoulder was more stable. Comparable results were observed in both below and above 40 age groups and those with injury to surgery interval less than 3 or 3–6 months.ConclusionTransfer of ulnar nerve fascicle to the motor branch of biceps close to the muscle consistently results in early and good recovery of elbow flexion. Shoulder abduction and external rotation show modest but useful recovery and about half can be expected to have active movements. Two patients in early fifties also achieved good results and hence this procedure should be offered to this age group also. Surgery done earlier to 6 months gives consistently good results.

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Fifteen finger tip amputations through the proximal half of the nail bed were reconstructed with palmar V-Y advancement flaps and full thickness nail bed grafts. The undersurface of the V-Y flap was sutured to the nail bed remnant and the raw area was covered with full thickness nail bed grafts from the amputated part. They were followed for a minimum period of one year and the nail bed grafts took fully in all patients. The results were best in the thumb and least favourable in the little finger but all the patients were happy with the cosmetic result and the functional outcome. This technique results in an average gain of 5 mm of extra length to the nail. This is a useful technique when replantation of a distal fingertip amputation is not possible.