Treatment of Fingertip Amputation in Adults by Palmar Pocketing of the Amputated Part

Abstract

BackgroundFirst suggested by Brent in 1979, the pocket principle is an alternative method for patients for whom a microsurgical replantation is not feasible. We report the successful results of a modified palmar pocket method in adults.MethodsBetween 2004 and 2008, we treated 10 patients by nonmicrosurgical replantation using palmar pocketing. All patients were adults who sustained a complete fingertip amputation from the tip to lunula in a digits. In all of these patients, the amputation occurred due to a crush or avulsion-type injury, and a microsurgical replantation was not feasible. We used the palmar pocketing method following a composite graft in these patients and prepared the pocket in the subcutaneous layer of the ipsilateral palm.ResultsOf a total of 10 cases, nine had complete survival of the replantation and one had 20% partial necrosis. All of the cases were managed to conserve the fingernails, which led to acceptable cosmetic results.ConclusionsA composite graft and palmar pocketing in adult cases of fingertip injury constitute a simple, reliable operation for digital amputation extending from the tip to the lunula. These methods had satisfactory results.

Improved Abdomen Hypodermic Embedding for Salvage of the Amputated Fingertip from Tip to Lunula (Tamai Zone Ⅰ)

“…Palmar digital veins only exist in the nger pulp or the slant ulnar side and the outer diameter is wee. According to this feature, the Tamai partition method divides the ngertip into two zones, the Zone I: the lunula (methyl) to the nger end; the Zone II: the distal interphalangeal joint to the lunula (methyl) [22]. All of our cases were belonged to Zone I.…”

“…Many scholars have improved it and achieved satisfactory results in this technology. Like abdomen hypodermic embedding, some scholars used other nger [19] or palm [20] to foster the smaller amputated ngertip. All of them have their respective advantages and disadvantages.…”

A perforator from the ulnar artery and cutaneous nerve of the hypothenar area: An anatomical study for clinical application

“…However, this technique has a higher rate of failure than other techniques, and this can eventually necessitate further surgery . Another method is known as palmar pocketing, wherein the amputated part is “pocketed” into palmar tissue . However, this method leads to hand stiffness because of the reconstructed finger being kept in a bent position for over 2–3 weeks, along with an extremely long period of rehabilitation.…”

Thumb fingertip reconstruction with palmar V–Y flaps combined with bone and nail bed grafts following amputation

“…The critical factor when utilizing bone and nail tissue as a graft for reconstruction is to choose a flap that is sufficiently vascular to nourish these grafts. Jung et al [2] reported that a subcutaneous pocket could provide extra blood supply for survival of the composite graft of the amputated fingertip by enlarging the area of vascular contact. Muneuchi et al [3] emphasized that the subcutaneous pocket technique be performed scrupulously for fingertip amputation across or proximal to the lunula because of the poor survival rate and the possibility of contracture of the digits or other proximal joints.…”